Pre-Analytical Considerations

Transcription

1 ➉ CD Roche Diagnostics Ltd. Forrenstrasse CH-6343 Rotkreuz Switzerland Heil/Ehrhardt s for Adults and Children 2008 s for Adults and Children Pre-Analytical Considerations 2008 W. Heil V. Ehrhardt

2 Preface, 9 th Edition In order to fulfill increased regulatory standards the contents of this brochure are now to orientate closer by the information included in the package inserts of Roche Diagnostics test kits. As a consequence a number of changes and modifications concerning the indicated reference ranges as well as the citated literature turned out to be necessary. The resulting number changes compared to the 8 th edition of this brochure necessitated the publication of a revised 9 th edition. As a result of differing printing dates, it is possible that differences may occur between the information given here and that appears in the package inserts. In such cases the data given in the insert, enclosed with the kit, applies. The reference ranges listed in this brochure are guide values which may depend on the specific method used. Therefore, each laboratory should investigate the transferability of the expected values to its own patient population and if necessary determine its own reference ranges. PD Dr. W. Heil, Wuppertal Dr. V. Ehrhardt, Mannheim Authors Dr. Wolfgang Heil, Wuppertal Dr. Volker Ehrhardt, Roche Diagnostics GmbH, Mannheim Roche Diagnostics GmbH Status: July 2008 Mannheim, March JANUAR_2010_ENGLISCH SEITE :44 3. Autorkorrektur

3 Contents Page List of abbreviations 4 1 Pre-analytical considerations Factors affecting blood collection Sample collection Transport and storage of sample material Assessment of sample material 12 2 Reference ranges Clinical chemistry and immunological tests, serum/plasma Hematology Coagulation Blood gases Therapeutic drug monitoring Urinalysis, urinary sediment and status Clinical chemical urinalysis Urinary calculi, gallstones CSF Stool Spermiogram Extravascular body fluids Function tests Characteristic analytes for identification of body fluids Decision supports Enzyme patterns Lipids Electrophoretic patterns of plasma proteins Schematic representation of blood coagulation Thrombophilia, risk factors 150 Page 3.6 Age dependence of immunoglobulin synthesis Complement system, classical and alternative mechanism Tumor markers Serological diagnosis of hepatitis A and B Urinary sediment Nomogram for diagnosing acid-base disorders Conversion tables Conversion table from conventional units to SI units and vice versa (/U refers to urinalysis) Conversion factors for enzyme activities: U/L «mkat/l and nkat/l Sample stability References List of key words 225 COBAS; CARDIAC M; INTEGRA; ELECSYS; REFLOTRON; Roche CARDIAC and TINA-QUANT are trademarks of Roche. 2 3 JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

4 List of abbreviations BSA C 4 bbp CA CO 2 CSF CTAD d DGKC EDTA EGTA ELISA Eq f g h H 2 Hb Hct (PCV) HPLC IFCC INR kat Body surface area C 4 -binding Protein Tumour-related carbohydrate antigen Carbon dioxide Cerebrospinal fluid Citrate, theophylline, adenosine, dipyridamole Day German Society of Clinical Chemistry Ethylene diamine tetraacetic acid 1,2-bis (2-amino ethoxyethane)tetraacetic acid Enzyme-linked immuno-sorbent assay Equivalent meq milliequivalent Female Gram mg Milligram (10 3 g) mg Microgram (10 6 g) ng Nanogram (10 9 g) pg Picogram (10 12 g) Hour Hydrogen Hemoglobin Hematocrit (packed cell volume) High pressure liquid chromatography International Federation of Clinical Chemistry International Normalized Ratio Katal mkat Millikatal (10 3 kat) mkat Microkatal (10 6 kat) nkat Nanokatal (10 9 kat) pkat Picokatal (10 12 kat) L m m MCH MCHC MCV mil min mol mosmol mth NACB NCEP NGSP O 2 Pa pco 2 Liter dl Deciliter (10 1 L) ml Milliliter (10 3 L) ml Microliter (10 6 L) nl Nanoliter (10 9 L) pl Picoliter (10 12 L) fl Femtoliter (10 15 L) Male Meter mm Millimeter (10 3 m) mm Micrometer (10 6 m) m 2 Square meter mm 3 Cubic micrometer Mean corpuscular hemoglobin Hb/RBC (hemoglobin content of one red cell) Mean corpuscular hemoglobin concentration Mean corpuscular volume Million Minute Mole mmol Millimole (10 3 mol) mmol Micromole (10 6 mol) nmol Nanomole (10 9 mol) pmol Picomole (10 12 mol) fmol Femtomole (10 15 mol) Milliosmole (10 3 osmole) Month National Academy of Clinical Biochemistry National Cholesterol Education Program National Glycohemoglobin Standardization Program Oxygen Pascal kpa (10 3 pascal) Partial pressure of carbon dioxide 4 5 JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

5 ph po 2 ppm pt s U UV w yr Negative decimal logarithm of the hydrogen ion activity Partial pressure of oxygen Parts per million Particle Mpt Megaparticle (10 6 particle) Gpt Gigaparticle (10 9 particle) Tpt Teraparticle (10 12 particle) Second Unit (international) ku Kilo unit (10 3 units) Ultraviolet Week Year 1 Pre-analytical considerations Assay findings in the field of clinical chemistry can be divided into the following categories: preanalytical phase analytical phase analytical evaluation postanalytical phase. The following chart illustrates details of the preanalytical and analytical phases as well as analytical and medical evaluation and how the individual steps are related to one another. The accuracy of a laboratory analysis greatly depends on the preanalytical phase. PATIENT FINDINGS Patient preparation Influence factors Sample transport Identity check Sample collection Sample material Patient data Quality control Medical evaluation Analytical evaluation Clinical questions Plausibility check Interferences Sample evaluation Sample preparation Analysis Value measured Result Method 6 7 JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

6 1.1 Influence factors The following should be taken into account during sample collection: After food intake glucose, cholesterol, triglycerides, iron, inorganic phosphate and amino acids are present in elevated concentrations in blood (103). If the patient is moved from a recumbent to an upright position, the concentration of corpuscular and macromolecular substances such as leucocytes, erythrocytes, hemoglobin, hematocrit, total protein, enzymes, lipoproteins and protein-bound ions (e. g. calcium, iron) increase by up to 10 %. Some drugs may affect the test performed. Compress vein for maximum 1 min. Large quantities of alcohol over an extended period of time cause an increase in g-gt activity, CDT and MCV. Smokers have elevated CO-Hb- and CEAconcentrations. Substantial diurnal variations can be observed in the case of some analytes, e. g. hormones (epinephrine, aldosterone, corticotropin, cortisol, norepinephrine, prolactin, somatotropin, testosterone), electrolyte excretion in urine, serum hemoglobin and iron. Therefore it is recommended to collect samples between 7 and 9 a.m. Patients undergoing tolerance tests should be prepared as described in section 2.12 Function tests. If possible, sample collection should always take place under standardized conditions, i. e. when the patient is fasting, always with the patient in the same position (seated or recumbent), around the same time of day and following brief venous stasis. 1.2 Sample collection Clinical chemistry: Clinical chemical assays are almost exclusively performed on serum or plasma. Serum is obtained from spontaneously coagulated whole blood, plasma via the addition of anticoagulants (EDTA, citrate, oxalate or heparinate). Differences between serum and plasma are generally observed in the determination of potassium, inorganic phosphate and LDH, and in electrophoresis of fibrinogen (281). In thrombocytosis patients with thrombocyte values above 500 q 10 3 /ml (500 Gpt/L) a potassium determination cannot be performed in serum; it is necessary to use heparinized plasma instead. Glucose: Since the rate of glycolysis is around 7 % per hour, a glycolysis inhibitor, e.g. sodium fluoride, mannose or iodoacetate must be added to the blood sample prior to determination of the glucose concentration. Hematology: In the vast majority of hematological analyses, venous blood treated with EDTA is used. In isolated cases, EDTA-induced pseudothrombocytopenia can develop, which is of no significance clinically. Use of citrated blood returns cell numbers to normal. Coagulation: In coagulation tests, citrated plasma (one part 3.2 % [0.11 mol/l]* sodium citrate solution and nine parts blood) is used for assay purposes. It is essential to mix the sodium citrate solution and the blood exactly in the relationship Blood treated with EDTA or oxalate cannot be used for coagulation assays, since these substances may cause more rapid * sometimes one part 3.9 % [0.129 mol/l] is used 8 9 JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

7 1.3 Transport and storage of sample material inactivation of factors V and VIII, for example. Hemolytic samples or samples which have started to coagulate should be discarded. Urine: In urinalysis it must be noted that there are considerable diurnal variations in the excretion of some substances, that urine must be pretreated for stabilization of catecholamines, for example, and that it is essential to collect all the urine excreted during the specified period. For the determination of calcium, the entire amount of urine excreted over 24 hours must be acidified and heated. CSF: CSF collected for the assay of clinical chemistry analytes should be treated with EDTA to preclude fibrin clot formation since an accurate cell count can otherwise not be obtained. Centrifugation should generally take place no more than 1 hour after sample collection. If samples are to be despatched, only serum or plasma should be used unless whole blood is absolutely necessary for the analysis. With regard to clinical chemical determinations, the use of a separator gel in the collection tube has proved advantageous in preventing cellular constituents from entering the serum. Clinical chemistry (102): Electrolytes, substrates and enzymes in the sample (serum, plasma) are usually stable for 4 days when stored in the refrigerator at +4 C (exceptions: acid phosphatase, ammonium, lactate) and are stable for at least one day at room temperature. If long-term storage is necessary, it is advisable to freeze the sample at 20 C unless it is to be used for determination of LDH, Lp[a] or a-hbdh. Repeated thawing should be avoided. Plasma glucose determinations: Plasma should be separated from cellular constituents (centrifuged) no later than 30 minutes after collection of the blood sample. Avoid hemolysis. Sample material which has been separated from cellular constituents or in which glycolysis has been prevented via the addition of a glycolysis inhibitor, e. g. sodium fluoride (NaF), can be refrigerated for up to 7 days. Hematology (96): When kept in the closed tube, the cellular constituents and hemoglobin are stable for one day. It should, however, be noted that the blood smear must be prepared within 3 hours (93). Coagulation (95, 101): In coagulation analysis, determination of the analytes should always take place as soon as possible. If this is not feasible, platelet-poor plasma must be frozen immediately at 20 C or 40 C. Plasma for Quick, PTT, thrombin time and fibrinogen can be stored for about 4 h at room temperature or in a refrigerator. Fibrinogen, protein C and AT III are stable for 7 days, protein S and factors V and VIII for 4 hours only. Urine: Urine sediment should be evaluated within 2 to 3 hours at the latest. Freezing or refrigeration of the specimen is not recommended because of salt precipitation. CSF (214): CSF cells must be counted within the period of one hour JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

8 1.4 Assessment of sample material Blood gases (184): Blood gas determinations should be performed immediately. If this is not possible, the blood specimens collected in glass containers can be placed in iced water for up to 2 hours. Hemolysis (102): Determination of potassium, magnesium or LDH is not possible even in slightly hemolytic serum. Considerable hemolysis also affects other tests. Bilirubinemia: To avoid interference by icteric samples, the visual recognition of hyperbilirubinemia is often not sufficiently sensitive. This is particularly true when samples are simultaneously colorized by other pigments (e.g., hemoglobin). Spectral bilirubin interferences can be removed by blanking, such as with the kinetic Jaff methods. Chemical bilirubin interference of H 2 O 2 - forming enzymatic methods based on the Trinder reaction can be avoided by selection and choice of optimal concentrations of test components. (84). Serum Indices: On the Roche/Hitachi, COBAS INTEGRA ¾ and cobas ¾ modular platforms Serum Indices (icterus, lipemia, hemolysis) are measured. The package inserts of Roche s clinical chemistry reagents indicate for every test the Serum Index (I, L, H) limit above which the method is significantly interfered. On the cobas ¾ platforms the Serum Index limits are electronically deposed and a Serum Index flag only appears if the respective test is actually significantly affected by the present interferent concentration. Lipemia: Lipemic sera may interfere with photometric determinations. In this case, it is necessary to remove the lipoproteins JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

9 2 Reference ranges 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Acetoacetate Adults mg/dl mmol/l 16 a 1 -Acid glycoprotein mg/dl g/l 237 CRM 470 standardization Acid phosphatase f < 6.5 U/L <0.108 mkat/l 218 Roche Diagnostics, (ACP), total m < 6.6 U/L <0.110 mkat/l a-naphthyl phosphate, pentandiole-activated, prostatic < 3.5 U/L <0.058 mkat/l Roche/Hitachi, cobas ¾ instru- ments total m < 7.3 U/L <0.120 mkat/l 218 COBAS INTEGRA ¾ instruments prostatic < 1.9 U/L <0.030 mkat/l Adenosine monophosphate, 3l-5l, cycl. (camp) Adrenocorticothrophic hormone, Corticotropin (ACTH) Alanine aminotransferase, glutamate pyruvate transaminase (GPT, ALAT, ALT) Adults f ng/ml nmol/l 43 EDTA plasma m ng/ml nmol/l Adults pg/ml pmol/l 218 Roche Diagnostics, ACTH Elecsys ¾, samples drawn 7 10 a.m. Newborns, children, adolescents 1 d <31 U/L <0.50 mkat/l 68 IFCC, without pyridoxal phosphate 2 5 d <52 U/L <0.85 mkat/l 6 d 6 mth <60 U/L <1.00 mkat/l 7 12 mth <57 U/L < 0.95 mkat/l 1 3 yr <39 U/L <0.65 mkat/l 4 6 yr <39 U/L <0.65 mkat/l 7 12 yr <39 U/L <0.65 mkat/l yr f <23 U/L <0.40 mkat/l m <26 U/L <0.45 mkat/l Children, adolescents <1 yr w/o pyp <56 U/L with pyp <71 U/L w/o pyp <0.93 mkat/l with pyp <1.18 mkat/l 1 3 yr <29 U/L <31 U/L <0.48 mkat/l <0.52 mkat/l 4 6 yr <29 U/L <36 U/L <0.48 mkat/l <0.60 mkat/l 7 12 yr <37 U/L <44 U/L <0.62 mkat/l <0.73 mkat/l yr <37 U/L <45 U/L <0.62 mkat/l <0.75 mkat/l 94 IFCC, with and without pyridoxal phosphate Adults, >17 yr f <33 U/L <0.52 mkat/l 218, 260 according to IFCC, without pyridoxal m <41 U/L <0.68 mkat/l phosphate Adults f <35 U/L <0.60 mkat/l 137, 218, IFCC, with pyridoxal phosphate, m <50 U/L <0.85 mkat/l 270 consensus values f <34 U/L <0.56 mkat/l 238 IFCC, with pyridoxal phosphate, m <45 U/L <0.74 mkat/l hospital patients JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

10 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Alanine aminotransferase, glutamate pyruvate transaminase (GPT, ALAT, ALT) Newborn 12 mth f <45 U/L <0.77 mkat/l 218, 299 IFCC, with pyridoxal phosphate m <45 U/L <0.77 mkat/l 13 mth 60 yr f <35 U/L <0.60 mkat/l m <40 U/L <0.68 mkat/l 61 a 90 yr f <28 U/L <0.48 mkat/l m <40 U/L <0.68 mkat/l >90 yr f <24 U/L <0.41 mkat/l m <38 U/L <0.65 mkat/l Adults, 18 yr f <46 U/L <0.77 mkat/l 227 Nordic Reference Interval Project m <45 U/L <0.75 mkat/l (NORIP), methods traceable to IFCC Adults f <32 U/L <0.53 mkat/l 218 Reflotron ¾, blood, serum, plasma m <41 U/L <0.68 mkat/l Albumin Adults g/dl g/l 218 Roche Diagnostics, bromocresol-green method, CRM 470 standardization g/dl g/l 218 Roche Diagnostics, immunoturbidimetric method, CRM 470 standardization g/dl g/l 218 Roche Diagnostics, bromocresol-purplemethod, CRM 470 standardization. Adults g/dl g/l 218, 237 CRM 470 standardization, consensus values 4 d g/dl g/l 218, 299 Bromocresol-green/bromocresol- 5 d 14 yr g/dl g/l purple/immunoturbidimetric/nephelo yr g/dl g/l metric methods, CRM 470 standardi- zation. Aldosterone Recumbent ng/l pmol/l 116 RIA, method-dependent Standing ng/l pmol/l Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

11 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Alkaline phosphatase (AP), total Children, 1 d <600 U/L <10.00 mkat/l 68 DGKC, optimized, recommendations 1972, adolescents 2 5 d <553 U/L <9.20 mkat/l calculated with a conversion factor of d 6 mth <1076 U/L <17.95 mkat/l (25 C fi 37 C) 7 12 mth <1107 U/L <18.45 mkat/l 1 3 yr <673 U/L <11.20 mkat/l 4 6 yr <644 U/L <10.75 mkat/l yr f m Adults f m 7 12 yr <720 U/L <12.00 mkat/l <448 U/L <7.45 mkat/l <936 U/L <15.60 mkat/l <240 U/L <270 U/L <4.00 mkat/l <4.50 mkat/l Children, <1 yr <390 U/L <6.50 mkat/l 94 IFCC adolescents 1 3 yr <409 U/L <6.82 mkat/l 4 6 yr <347 U/L <5.78 mkat/l 7 12 yr f <312 U/L <5.20 mkat/l m yr f m yr f m >60yr f m Adults f m <316 U/L <329 U/L <381 U/L <98 U/L <128 U/L <141 U/L <119 U/L <105 U/L <130 U/L <5.27 mkat/l <5.48 mkat/l <6.35 mkat/l <1.65 mkat/l <2.15 mkat/l <2.35 mkat/l <2.00 mkat/l <1.75 mkat/l <2.20 mkat/l Notes 224 DGKC (calculated for 37 C) 272 IFCC 270 Consensus values of DGKC and VDGH Children, 1 d <250 U/L <4.17 mkat/l 218, 68 Calculated from data published for the ALP opt. adolescents 2 5 d <231 U/L <3.84 mkat/l method (DGKC) using a factor of d 6 mth <449 U/L <7.49 mkat/l 7 12 mth <462 U/L <7.69 mkat/l 1 3 yr <281 U/L <4.67 mkat/l 4 6 yr <269 U/L <4.48 mkat/l 7 12 yr <300 U/L <5.00 mkat/l yr f m <187 U/L <390 U/L <3.11 mkat/l <6.51 mkat/l bone Adults f m <120 U/L <150 U/L <2.00 mkat/l <2.50 mkat/l 224 DGKC (calculated for 37 C) Aluminium Adults <3 mg/l <0.11 mmol/l 67 Use only tubes specifically designed for determination of trace elements JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

12 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Ammonia Adults f <82 mg/dl <48 mmol/l 218 Roche/Hitachi instruments m <94mg/dL <55 mmol/l f <87 mg/dl <51 mmol/l 218 COBAS INTEGRA ¾ /cobas ¾ instruments m <102 mg/dl <60 mmol/l a-amylase, total Adults <100 U/L <1.67 mkat/l 218 IFCC, Reflotron ¾, COBAS INTEGRA ¾, cobas ¾, Roche/Hitachi instruments a-amylase, <1 yr <8 U/L <0.13 mkat/l 2 IFCC pancreatic 1 9 yr <31 U/L <0.52 mkat/l yr <39 U/L <0.65 mkat/l Adults <53 U/L <0.90 mkat/l 218 Reflotron ¾, COBAS INTEGRA ¾, cobas ¾, Roche/Hitachi instruments Amyloid A mg/l mg/l 155 Anion gap 8 16 mmol/l 8 16 mmol/l 194 Antibody to cyclic citrullinated peptide (Anti-CCP) Anti-DNAse B Children 2 yr Antistreptolysin O (ASLO) Anti-thyreoglobulin, thyreoglobulin autoantibodies (Anti-TG) 17 U/mL 17 U/mL 218 Anti-CCP Elecsys ¾ Optimum cut-off (sensitivity: 67.7 %; specificity: 97.0 %) 3yr <240 U/mL <60 U/mL <240 ku/l <60kU/L 4 yr <240 U/mL <240 ku/l 5 yr <320 U/mL <320 ku/l 6 yr <480 U/mL <480 ku/l 7 10 yr <640 U/mL <640 ku/l 11 yr <800 U/mL <800 ku/l 12 yr <480 U/mL <480 ku/l Adults <480 U/mL <480 ku/l Children 2 yr <160 U/mL <160 ku/l 131 Reference ranges vary with season and 3 4 yr <120 U/mL <120 ku/l geographical area. 5 yr <160 U/mL <160 ku/l 6 9 yr <240 U/mL <240 ku/l yr <320 U/mL <320 ku/l Adults Children <6 yr 6 18 yr <200 U/mL <150 U/mL U/mL <200 ku/l <150 ku/l ku/l , 292 Immunoturbidimetric method, COBAS INTEGRA ¾, cobas ¾, Roche/Hitachi instruments Children, adolescents Newborn <134 U/mL <134 ku/l 219 Anti-TG Elecsys ¾, reference range study 6 d 3 mth <146 U/mL <146 ku/l 4 12 mth <130 U/mL <130 ku/l 1 6 yr <38 U/mL <38 ku/l 7 11 yr <37 U/mL <37 ku/l yr <64 U/mL <64 ku/l Healthy subjects <115 U/mL <115 ku/l 218 Anti-TG Elecsys ¾ JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

13 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Anti-thyroidea peroxidase, thyroid peroxidase antibodies (Anti-TPO) Children, adolescents Newborn <117 U/mL <117 ku/l 219 Anti-TPO Elecsys ¾ 6 d 3 mth <47 U/mL <47 ku/l 4 12 mth <32 U/mL <32 ku/l 1 6 yr <13 U/mL <13 ku/l 7 11 yr <18 U/mL <18 ku/l yr <26 U/mL <26 ku/l Healthy subjects <34 IU/mL <34 kiu/l 218 a 1 -Antitrypsin <1 mth mg/dl mmol/l 54 Immunonephelometric assay, 2 6 mth mg/dl mmol/l CRM 470 standardization 7 mth 2 yr mg/dl mmol/l 3 yr 19 yr mg/dl mmol/l Adults mg/dl mmol/l 218, 237 Immunoturbidimetric assay, CRM 470 standardization Anti-TSHR Healthy subjects Negative: <1.5 U/L Negative: <1.5 U/L 218 Anti-TSHR Elecsys ¾ (antibodies to Indeterminate: U/L Indeterminate: U/L TSH receptor) Positive: >1.75 U/L Positive: >1.75 U/L Apolipoprotein A-I Adults f mg/dl g/l 218 m mg/dl g/l Apolipoprotein B Adults f g/l mmol/l 218 m g/l mmol/l Aspartate aminotransferase, glutamate oxaloacetate aminotransaminase (GOT, ASAT, AST) Children, adolescents 1 d <122 U/L <2.05 mkat/l 68 IFCC, without pyridoxal phosphate 2 5 d <110 U/L <1.85 mkat/l 6 d 6 mth <84 U/L <1.40 mkat/l 7 12 mth <89 U/L <1.50 mkat/l 1 3 yr <56 U/L <0.95 mkat/l 4 6 yr <52 U/L <0.85 mkat/l 7 12 yr <51 U/L <0.85 mkat/l yr f <27 U/L <0.45 mkat/l m <33 U/L <0.60 mkat/l Notes Children, adolescents <1 yr w/o pyp <58 U/L with pyp <96 U/L w/o pyp <0.97 mkat/l with pyp <1,60 mkat/l 1 3 yr <59 U/L <71 U/L <0.98 mkat/l <1.18 mkat/l 4 6 yr <48 U/L <53 U/L <0.80 mkat/l <0.88 mkat/l 7 12 yr <44 U/L <50 U/L <0.73 mkat/l <0.83 mkat/l yr <39 U/L <46 U/L <0.65 mkat/l <0.77 mkat/l 94 IFCC, with and without pyridoxal phosphate JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

14 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Aspartate aminotransferase, glutamate oxaloacetate aminotransaminase (GOT, ASAT, AST) Adults f <35 U/L <0.60 mkat/l 137, 218, IFCC, with pyridoxal phosphate m <50 U/L <0.85 mkat/l 270 f <31 U/L <0.52 mkat/l 238 IFCC, with pyridoxal phosphate, m <35 U/L <0.58 mkat/l hospitalized patients f <35 U/L <0.58 mkat/l 227 Nordic Reference Interval Project m <45 U/L <0.75 mkat/l (NORIP), methods traceable to IFCC Notes f m 32 U/L 40 U/L 0.53 mkat/l 0.67 mkat/l 218, 260 Acc. to the optimized standard method (comparable to the IFCC method without pyridoxal phosphate activation), calculated values (25 C fi 37 C). f <33 U/L <0.55 mkat/l 218 Reflotron ¾, blood, serum, plasma m <40 U/L <0.67 mkat/l Bilirubin, total Neonates 1 d < 8.2 mg/dl < 140 mmol/l 134 (premature) 2 d < 12 mg/dl < 205 mmol/l 3 5 d < 24 mg/dl < 410 mmol/l 4 w < 1.5 mg/dl < 26 mmol/l Newborns (full term), children 1 d <8.7 mg/dl <150 mmol/l d <11.3 mg/dl <193 mmol/l 3 d <12.7 mg/dl <217 mmol/l 4 6 d <12.6 mg/dl <216 mmol/l >1 mth <1.0 mg/dl <17 mmol/l Adults <1.1 mg/dl <18.7 mmol/l 285 Bilirubin, direct <0.2 mg/dl <3.4 mmol/l 299 (conjugated) <0.1 mg/dl <1.7 mmol/l 264 Neonates <0.6 mg/dl <10 mmol/l 247 CA 15 3 <25 U/mL <25 ku/l 218 CA 15 3 Elecsys ¾ CA 19 9 <27 U/mL <27 ku/l 218 CA 19 9 Elecsys ¾ CA 72 4 <6.9 U/mL <6.9 ku/l 218 CA 72 4 Elecsys ¾ CA 125 <35 U/mL <35 ku/l 218 CA 125 II Elecsys ¾ C 3C -complement mg/dl g/l 237 CRM 470 standardization C 4 -complement mg/dl g/l 237 CRM 470 standardization Cadmium <2.7 mg/l <24 nmol/l 82 Whole blood, AAS Calcitonin Adults f 14 ng/l 3.9 pmol/l 299 m 19 ng/l 5.3 pmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

15 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Calcium, total Adults mg/dl mmol/l 266 Photometric assay mg/dl mmol/l 266 AAS Cord blood mg/dl mmol/l 299 Newborns, premature mg/dl mmol/l Children <10 d mg/dl mmol/l 11 d 2 yr mg/dl mmol/l 3 12 yr mg/dl mmol/l yr mg/dl mmol/l Adults yr mg/dl mmol/l yr mg/dl mmol/l >90 yr mg/dl mmol/l mg/dl mmol/l 218 Roche/Hitachi, COBAS INTEGRA ¾, cobas ¾ systems. Calcium, Adults mg/dl mmol/l 244 free, ionized mg/dl mmol/l 266 Carcinoembryonic Non-smokers yr 3.8 ng/ml 3.8 mg/l 218 CEA Elecsys ¾ antigen (CEA) 40 yr 5.0 ng/ml 5.0 mg/l Smokers yr 5.5 ng/ml 5.5 mg/l 70 yr 6.5 ng/ml 6.5 mg/l Carnitin, free 1 12 mth mg/dl mmol/l yr mg/dl mmol/l 8 15 yr mg/dl mmol/l Adults f mg/dl mmol/l 242 m mg/dl mmol/l Catecholamines Norepinephrine ng/l pmol/l 206 Plasma with addition of glutathione and EGTA Epinephrine ng/l pmol/l Dopamine ng/l pmol/l Ceruloplasmin mg/dl mmol/l 218, 237 Immunoturbidimetric method, CRM 470 standardization Chloride Children 1 7 d meq/l mmol/l 247 ISE 8 d 1 mth meq/l mmol/l 2 6 mth meq/l mmol/l 7 mth 1 yr meq/l mmol/l >1 yr meq/l mmol/l Adults meq/l mmol/l 218, 299 Indirect ISE, coulometry meq/l mmol/l 218 Direct ISE JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

16 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Cholesterol, total 1 30 d f mg/dl mmol/l 247 EDTA plasma yields 3 6 % lower values m mg/dl mmol/l than serum d f mg/dl mmol/l m mg/dl mmol/l d f mg/dl mmol/l m mg/dl mmol/l 1 3 yr f mg/dl mmol/l m mg/dl mmol/l 4 6 yr f mg/dl mmol/l m mg/dl mmol/l 7 9 yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l No risk <200 mg/dl <5.2 mmol/l 46 Classification acc. to NCEP ATP III Moderate risk mg/dl mmol/l High risk 240 mg/dl 6.2 mmol/l Cholesterol, HDL Major risk 40 mg/dl <1.0 mmol/l 46 Classification acc. to NCEP ATP III Negative risk 60 mg/dl <1.6 mmol/l No risk f m >65 mg/dl >55 mg/dl >1.68 mmol/l >1.45 mmol/l Moderate risk f mg/dl mmol/l m mg/dl mmol/l High risk f <45 mg/dl <1.15 mmol/l m <35 mg/dl <0.90 mmol/l Cholesterol, LDL Adults <155 mg/dl <4.0 mmol/l European guidelines Adult levels Optimum <100 mg/dl <2.59 mmol/l 46, 218 Classification acc. to NCEP ATP III Near/above optimum mg/dl mmol/l Borderline high mg/dl mmol/l High mg/dl mmol/l Very high 190 mg/dl 4.92 mmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

17 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Cholinesterase (CHE) m, w >41 yr ku/l mkat/l 29, 218 Pseudocholinesterase, butyrylthiocholine iodide, Roche Diagnostics ku/l mkat/l Calculated with a temperature conversion factor of 1.52 (25 fi 37 C) w, yr, not pregnant, not taking oral contraceptives w, yr, pregnant or taking oral contraceptives ku/l mkat/l Dibucaine Normal individuals Inhibition: >75 % Inhibition: > inhibition test Chromium Fasting volunteers mg/l nmol/l 241 Special tubes required Copper <4 mth mg/dl mmol/l mth mg/dl 4 17 mmol/l 7 12 mth mg/dl 8 21 mmol/l 1 5 yr mg/dl mmol/l 6 9 yr mg/dl mmol/l yr mg/dl mmol/l yr f mg/dl mmol/l m mg/dL mmol/l Adults f mg/dl mmol/l 171 m mg/dL mmol/l Cortisol 7 10 h mg/dl nmol/l 218 Cortisol Elecsys ¾ h mg/dl nmol/l C-peptide of insulin ng/ml nmol/l 218 C-peptide Elecsys ¾ C-reactive Protein (CRP) Adults <0.50 mg/dl <47.6 nmol/l 89, 218 Immunoturbidimetric method, CRM 470 standardization, consensus value for adults high sensitive Neonates <3 w <0.41 mg/dl <39.0 nmol/l 218, 233 Immunoturbidimetric method, Children 2 mth 15 yr <0.28 mg/dl <26.7 nmol/l CRM 470 standardization Adults <0.50 mg/dl <47.6 nmol/l f yr <0.85 mg/dl <80.9 nmol/l 105 Immunonephelometric method, >65 yr <0.66 mg/dl <62.8 nmol/l CRM 470 standardization m yr <0.79 mg/dl <75.2 nmol/l >65 yr <0.68 mg/dl <64.7 nmol/l Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

18 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Creatine kinase 1 d <712 U/L <11.9 mkat/l 68 NAC activated, DGKC, optimized, (CK), total 2 5 d <652 U/L <10.9 mkat/l recommendations d 6 mth <295 U/L <4.90 mkat/l 7 12 mth <203 U/L <3.40 mkat/l 1 3 yr <228 U/L <3.80 mkat/l 4 6 yr <149 U/L <2.50 mkat/l 7 12 yr f <154 U/L <2.55 mkat/l m <247 U/L <4.10 mkat/l yr f <123 U/L <2.05 mkat/l m <270 U/L <4.50 mkat/l Adults f <180 U/L <2.01 mkat/l 218, 299 m <200 U/L <3.34 mkat/l Adults f <170 U/L <2.85 mkat/l 137, 218 Consensus values m <190 U/L <3.20 mkat/l f <192 U/L <3.21 mkat/l 138, 218 m <308 U/L <5.14 mkat/l f <145 U/L <2.41 mkat/l 217, 238 IFCC, hospital patients m <171 U/L <2.85 mkat/l f <170 U/L <2.84 mkat/l 218 Roche Diagnostics, Reflotron ¾ m <195 U/L <3.26 mkat/l Creatine kinase MB (CK-MB) Adults <25 U/L <0.42 mkat/l 269, 218 Consensus values mass Adults f <2.88 ng/ml <2.88 mg/l 218 CK-MB Elecsys ¾ m <4.94 ng/ml <4.94 mg/l Creatinine Neonates, premature <1.04 mg/dl <91 mmol/l 218, 233 Jaff method, Roche Diagnostics Neonates, full term <0.85 mg/dl <75 mmol/l Children 2 12 mth <0.42 mg/dl <37 mmol/l 1 2 yr <0.41 mg/dl <36 mmol/l 3 4 yr <0.47 mg/dl <42 mmol/l 5 6 yr <0.59 mg/dl <52 mmol/l 7 8 yr <0.60 mg/dl <53 mmol/l 9 10 yr <0.73 mg/dl <65 mmol/l yr <0.79 mg/dl <70 mmol/l yr <0.87 mg/dl <77 mmol/l Adults f <0.90 mg/dl <80 mmol/l 172, 218 Jaff method, Roche Diagnostics m <1.20 mg/dl <106 mmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

19 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Creatinine Neonates, premature <0.98 mg/dl <87 mmol/l 218, 233 Enzymatic method, Roche Diagnostics Neonates, full term <0.88 mg/dl <77 mmol/l Children 2 12 mth <0.39 mg/dl <34 mmol/l 1 2 yr <0.35 mg/dl <31 mmol/l 3 4 yr <0.42 mg/dl <37 mmol/l 5 6 yr <0.47 mg/dl <42 mmol/l 7 8 yr <0.53 mg/dl <47 mmol/l 9 10 yr <0.64 mg/dl <56 mmol/l yr <0.68 mg/dl <60 mmol/l yr <0.77 mg/dl <68 mmol/l Adults f <0.95 mg/dl <84 mmol/l 172, 218 Enzymatic method, Roche Diagnostics m <1.17 mg/dl <104 mmol/l b-crosslaps w premenopausal <573 pg/ml <573 ng/l 218 b-cross Laps Elecsys ¾ postmenopausal <1008 pg/ml <1008 ng/l For postmenopausal women on hormon m yr <584 pg/ml <584 ng/l replacement therapy the ref. values yr <704 pg/ml <704 ng/l of premenopausal women are valid. >70 yr <854 pg/ml <854 ng/l CYFRA 21 1 < 3.3 ng/ml <3.3 mg/l 218 CYFRA 21 1 Elecsys ¾ Cystatin C Children <1 mth mg/l mg/l mth mg/l mg/l >12 mth mg/l mg/l Adults yr mg/l mg/l 190 >50 yr mg/l mg/l Adults yr mg/l mg/l 218 Roche Diagnostics, Roche/Hitachi, COBAS INTEGRA ¾, cobas ¾ systems. Dehydroepiandrosterone sulfate (DHEA-S) yr f mg/dl mmol/l 218 DHEA-S Elecsys ¾ m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l 75 yr f mg/dl mmol/l m mg/dl mmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

20 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Dehydroepiandrosterone sulfate (DHEA-S) Children <1 w mmol/l mg/dl 218 DHEA-S Elecsys ¾ 1 4 w mmol/l mg/dl 1 12 m mmol/l mg/dl 1 4 yr mmol/l mg/dl 5 9 yr mmol/l mg/dl Elastase Healthy lab. workers <160 mg/l <160 mg/l 186 ELISA, reference range depends on test used. Erythropoietin 1 3 yr f <15.9 U/L <15.9 U/L 143 Serum m <17.9 U/L <17.9 U/L 4 6 yr f <8.5 U/L <8.5 U/L m <21.9 U/L <21.9 U/L 7 9 yr f <8.2 U/L <8.2 U/L m <13.5 U/L <13.5 U/L yr f <9.1 U/L <9.1 U/L m <14.0 U/L <14.0 U/L yr f <20.5 U/L <20.5 U/L m <14.4 U/L <14.4 U/L yr f <14.2 U/L <14.2 U/L m <15.2 U/L <15.2 U/L Adults 5 25 U/L 5 25 U/L Estradiol (E2) 1 10 yr f pg/ml pmol/l 218 Estradiol II Elecsys ¾ m pg/ml pmol/l f Follicular phase pg/ml pmol/l Ovulatory phase pg/ml pmol/l Luteal phase pg/ml pmol/l Postmenopause pg/ml pmol/l Pregnancy, 1st trimester pg/ml pmol/l m pg/ml pmol/l Estriol (E3) Pregnants w ng/ml nmol/l w ng/ml nmol/l w ng/ml nmol/l w ng/ml nmol/l Fatty acids, free Adults <20 mg/dl <0.7 mmol/l 16 Ferritin Children, adolescents <1 yr ng/ml mg/l yr 6 67 ng/ml 6 67 mg/l 4 6 yr 4 67 ng/ml 4 67 mg/l 7 12 yr f m 7 84 ng/ml ng/ml 7 84 mg/l mg/l yr f m ng/ml ng/ml mg/l mg/l yr f ng/ml mg/l 164, 218 Elecsys ¾ Ferritin yr m ng/ml mg/l Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

21 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI a 1 -Fetoprotein (AFP) Children, adolescents <30 d 50,0 100,000 ng/ml ,000 U/mL mth ng/ml U/mL 4 mth 18 yr <12.0 ng/ml <9.96 U/mL Notes Pregnancy w 14 <27.9 ng/ml <23.2 U/mL 218 AFP Elecsys ¾ (median) w 15 <30.9 ng/ml <25.6 U/mL w 16 <36.1 ng/ml <30.0 U/mL w 17 <40.4 ng/ml <33.5 U/mL w 18 <48.3 ng/ml <40.1 U/mL w 19 <54.8 ng/ml <45.5 U/mL Adults 7.0 ng/ml 5.8 U/mL Fluoride Adults mg/l mmol/l 196 Heparin plasma Folic acid, serum 1 yr f ng/ml nmol/l 109 m ng/ml nmol/l 2 3 yr f ng/ml nmol/l m ng/ml nmol/l 4 6 yr f ng/ml nmol/l m ng/ml nmol/l 7 9 yr f ng/ml nmol/l m ng/ml nmol/l yr f ng/ml nmol/l m ng/ml nmol/l yr f ng/ml nmol/l m ng/ml nmol/l Normal ng/ml nmol/l 145 Borderline deficient ng/ml nmol/l Deficient <2.2 ng/ml <5.0 nmol/l Excessive >17.5 ng/ml >39.7 nmol/l ng/ml nmol/l 218 Folate III Elecsys ¾ ; European study (USA: see package insert) Folic acid, red blood cells (RBC Folate) Follicle stimulating hormone (FSH) ng/ml nmol/l 218 RBC Folate II Elecsys ¾ ; European study, MODULAR ANALYTICS E 170, cobas ¾ e 601 (USA, Australia: see package insert) ng/ml nmol/l Elecsys ¾ 2010, cobas ¾ e 411 f Follicular phase mu/ml U/L 218 FSH Elecsys ¾ Ovulatory phase mu/ml U/L Luteal phase mu/ml U/L Postmenopause mu/ml U/L m mu/ml U/L JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

22 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI free PSA/total PSA > Free PSA Elecsys ¾, probability of finding ratio (fpsa/tpsa) m yr 49.2 % 26.9 % 18.3 % 9.1 % prostate cancer by age in years yr 57.5 % 33.9 % 23.9 % 12.2 % 70 yr 64.5 % 40.8 % 29.7 % 15.8 % Free thyroxine (FT 4 ) Free triiodothyronine (FT 3 ) Adults m ng/dl pmol/l 219 FT 4 Elecsys ¾ f ng/dl pmol/l Pregnants 1st trimester ng/dl pmol/l 2nd trimester ng/dl pmol/l 3rd trimester ng/dl pmol/l Children, adolescents Newborn ng/dl pmol/l 6 d 3 mth ng/dl pmol/l 4 12 mth ng/dl pmol/l 1 6 yr ng/dl pmol/l 7 11 yr ng/dl pmol/l yr ng/dl pmol/l ng/dl pmol/l 218 FT 4 Elecsys ¾ Adults ng/dl pmol/l 146 FT 4 Elecsys ¾, healthy blood donors, selected acc. to NACB recommendations Adults m pg/ml pmol/l 219 FT 3 Elecsys ¾ f On contraceptiva pg/ml pmol/l Not on contraceptiva pg/ml pmol/l Pregnants 1st trimester pg/ml pmol/l 2nd trimester pg/ml pmol/l 3rd trimester pg/ml pmol/l Children, adolescents Newborn pg/ml pmol/l 6 d 3 mth pg/ml pmol/l 4 12 mth pg/ml pmol/l 1 6 yr pg/ml pmol/l 7 11 yr pg/ml pmol/l yr pg/ml pmol/l Adults, euthyroid pg/ml pmol/l 218 FT 3 Elecsys ¾, routine samples from commercial laboratory pg/ml pmol/l FT 3 Elecsys ¾, apparently healthy blood donors Adults pg/ml pmol/l FT 3 Elecsys ¾, healthy blood donors, selected acc. to NACB recommendations Fructosamine Adults mmol/l mmol/l 295 Fructose Adults <0.6 mg/dl <0.03 mmol/l 123 FTI CEDIA ¾ T-uptake JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

23 2.1 Clinical chemistry and immunological tests, serum/plasma FT 4 I Analyte s References Group Conventional SI Euthyroid subjects Germany, Japan USA mg/dl mg/dl nmol/l nmol/l Notes 218, 219 T 4 Elecsys ¾ and T-uptake Elecsys ¾ Adults m mg/dl nmol/l 219 T 4 Elecsys ¾ and T-uptake Elecsys ¾ f On contraceptiva mg/dl nmol/l Not on contraceptiva mg/dl nmol/l Children, adolescents Newborn mg/dl nmol/l 6 d 3 mth mg/dl nmol/l 4 12 mth mg/dl nmol/l 1 6 yr mg/dl nmol/l 7 11 yr mg/dl nmol/l yr mg/dl nmol/l Galactose Adults <0.5 mg/dl <0.03 mmol/l 123 Gastrin pg/ml pmol/l 252 Fasting, deep-freeze immediately, RIA Glucose Newborns Cord blood mg/dl mmol/l 265 Criteria for diagnosing diabetes mellitus (67): 1 h mg/dl mmol/l 1. Incidental glucose concentration >200 mg/dl 2 h mg/dl mmol/l (11.1 mmol/l) or 5 14 h mg/dl mmol/l 2. Fasting glucose >126 mg/dl (7 mmol/l) or h mg/dl mmol/l 3. Glucose concentration 2 hours after h mg/dl mmol/l ogtt >200 mg/dl (11.1 mmol/l) Children (fasting) mg/dl mmol/l Adults mg/dl mmol/l 299 Plasma is recommended yr mg/dl mmol/l >90 yr mg/dl mmol/l Children mg/dl mmol/l Newborns 1 d mg/dl mmol/l 298 >1 d mg/dl mmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

24 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Glucose Fetal mg/dl mmol/l 78 Plasma Infants mg/dl mmol/l Adults mg/dl mmol/l Adults Venous plasma mg/dl mmol/l 218, 265 Following the recommendations of the ADA Venous whole blood mg/dl mmol/l reagarding Impaired Fasting Glucose, Capillary whole blood mg/dl mmol/l non-pregnants Capillary plasma mg/dl mmol/l Glutamate dehydrogenase (GLDH) Pregnants Venous plasma mg/dl mmol/l 265 Following the recommendations of the Venous whole blood mg/dl mmol/l Deutsche Diabetesgesellschaft and the Capillary whole blood mg/dl mmol/l Deutsche Gesellschaft får Gynåkologie Capillary plasma mg/dl mmol/l und Geburtshilfe Preprandial mg/dl mmol/l 265 Plasma (venous, capillary) 1 h postprandial <140 mg/dl <7.8 mmol/l 2 h postprandial <120 mg/dl <6.7 mmol/l <126 mg/dl <7.0 mmol/l 259 Fasting plasma glucose, Expert Committee on the Diagnosis and Classification of Diabetes mellitus/ada Adults mg/dl mmol/l 218 Reflotron ¾ system, blood, serum, plasma Newborns <11.7 U/L <195 nkat/l 218, 278, DGKC, optimized, recommendations 1972, Children 1 30 d <10.6 U/L <177 nkat/l 300 calculated values (25 fi 37 C) 1 6 mth <6.8 U/L <113 nkat/l 7 12 mth <5.6 U/L <93 nkat/l mth <4.5 U/L <75 nkat/l 2 3 yr <4.2 U/L <70 nkat/l yr <5.1 U/L <85 nkat/l Adults f <4.8 U/L <80 nkat/l 218 DGKC, optimized, m <6.4 U/L <110 nkat/l calculated values (25 fi 37 C) f <5 U/L <80 nkat/l 218, 270 Consensus values m <7 U/L <120 nkat/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

25 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI g-glutamyl transferase (g-gt) Newborns, children, adolescents 1 d <151 U/L <2.50 mkat/l 68 Method according to Szasz 2 5 d <185 U/L <3.10 mkat/l 6 d 6 mth <204 U/L <3.40 mkat/l 7 12 mth <34 U/L <0.55 mkat/l 1 3 yr <18 U/L <0.30 mkat/l 4 6 yr <23 U/L <0.40 mkat/l 7 12 yr <17 U/L <0.30 mkat/l yr f <33 U/L <0.55 mkat/l m <45 U/L <0.75 mkat/l Children, adolescents <1 yr <203 U/L <3.38 mkat/l 94 IFCC 1 3 yr <87 U/L <1.45 mkat/l 4 6 yr <26 U/L <0.43 mkat/l 7 12 yr <31 U/L <0.52 mkat/l yr <29 U/L <0.48 mkat/l Adults f <36 U/L <0.60 mkat/l 1, 218 Standardized according to Szasz m <61 U/L <1.02 mkat/l f <42 U/L <0.70 mkat/l 218 Standardized according to IFCC m <71 U/L <1.19 mkat/l f <40 U/L <0.67 mkat/l 270 IFCC, consensus values m <60 U/L <1.00 mkat/l f <38 U/L <0.63 mkat/l 238 IFCC, hospital patients m <55 U/L <0.92 mkat/l Glycerol, free Adults mg/dl mmol/l 16 Growth hormone Adults <5 mg/l <5 mg/l 161 Fasting, RIA (STH, somatotropin) Haptoglobin Adults mg/dl mmol/l 218, 237 Immunoturbidimetry, CRM 470 standardization Hp 1 1 f mg/dl mmol/l 153 Immunonephelometric assay m mg/dl mmol/l Hp 2 1 f mg/dl mmol/l m mg/dl mmol/l Hp 2 2 f mg/dl mmol/l m mg/dl mmol/l HbA 1c Healthy metabolism % , 218 Immunoturbidimetric assay, IFCC values % DCCT/NGSP values Hemoglobin Outpatients <6 mg/dl <60 mg/l 24 EDTA tubes, method according to Harboe (free Hb in plasma) Hemopexin Adults f mg/dl g/l 173 m mg/dl g/l Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

26 2.1 Clinical chemistry and immunological tests, serum/plasma Human chorionic gonadotropin (hcg) a-hydroxybutyrate dehydrogenase (a-hbdh) f f Premenopause, non-pregnant <1 mu/ml <1 U/L 218 hcg + b Elecsys ¾, pregnant women: see package insert. Postmenopause <7 mu/ml <7 U/L m <2 mu/ml <2 U/L Premenopause, <1 mu/ml <1 U/L 218 hcg STAT Elecsys ¾ non-pregnant Postmenopause <7 mu/ml <7 U/L m <3 mu/ml <3 U/L Adults <182 U/L <3.03 mkat/l 64, 218 DGKC, opt., recommendations 1972, calculated with a conversion factor (25 fi 37 C) b-hydroxybutyrate Adults mg/dl mmol/l 16 Analyte s References Group Conventional SI Homocysteic acid f <30 yr mg/l 6 14 mmol/l yr mg/l 5 13 mmol/l >60 yr mg/l 7 14 mmol/l m <30 yr mg/l 6 14 mmol/l yr mg/l 6 16 mmol/l yr mg/l 6 17 mmol/l >85 yr mg/l mmol/l Hydroxyprogesterone Adults f ng/ml nmol/l 286 m ng/ml nmol/l Immunoglobulin A, <1 yr <81 mg/dl <5.06 mmol/l 160, 218 Values recalculated (WHO, fi CRM 470 IgA 1 3 yr mg/dl mmol/l standardization) 4 6 yr mg/dl mmol/l 7 9 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l Adults mg/dl mmol/l 89, 218 Immunoturbidimetric method, CRM 470 standardization Immunoglobulin D, Adults mg/dl g/l 299 IgD Immunoglobulin E, Neonates <0.36 mg/dl <1.5 U/mL 53, 218 IgE Children, adolescents 1 yr <3.6 mg/dl <15 U/mL 2 5 yr <14.4 mg/dl <60 U/mL 6 9 yr <21.6 mg/dl <90 U/mL yr <48 mg/dl <200 U/mL Adults <24 mg/dl <100 U/mL Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

27 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Immunoglobulin G, Neonates mg/dl mmol/l 160 Immunonephelometric method, values IgG 1 3 yr mg/dl mmol/l recalculated (WHO, fi CRM 470 standardization) 4 6 yr mg/dl mmol/l 7 9 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l Adults mg/dl g/l 89, 218 Immunoturbidimetric method, CRM 470 standardization IgG subclasses IgG 1 IgG 2 IgG 1 IgG 2 5 yr mg/dl g/l yr mg/dl g/l 7 yr mg/dl g/l 8 yr mg/dl g/l 9 yr mg/dl g/l 10 yr mg/dl g/l 11 yr mg/dl g/l 12 yr mg/dl g/l 13 yr mg/dl g/l Adults mg/dl g/l IgG 3 IgG 4 IgG 3 IgG 4 5 yr mg/dl g/l 6 yr mg/dl g/l 7 yr mg/dl g/l 8 yr mg/dl g/l 9 yr mg/dl g/l 10 yr mg/dl g/l 11 yr mg/dl g/l 12 yr mg/dl g/l 13 yr mg/dl g/l Adults mg/dl g/l Immunoglobulin M, Children, adolescents IgM <1 yr <1.21 g/l <1.24 mmol/l 160 Immunonephelometric method, values recalculated (WHO, fi CRM 470 standardization) 1 3 yr g/l mmol/l 4 6 yr g/l mmol/l 7 9 yr g/l mmol/l yr g/l mmol/l yr g/l mmol/l yr g/l mmol/l yr g/l mmol/l Adults g/l mmo/l 89, 218 Immunoturbidimetry, CRM 470 standardization JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

28 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Immunoglobulin light chains kappa mg/dl g/l 218 Immunoturbidimetric assay, lambda mg/dl g/l CRM 470 standardization kappa/lambda ratio Insulin Healthy individuals mu/ml pmol/l 218 Insulin Elecsys ¾, fasting Iron 1 30 d f mg/dl mmol/l 246 m mg/dL mmol/l 1 12 mth f mg/dl mmol/l m mg/dL mmol/l 1 3 yr f mg/dl mmol/l m 29 91mg/dL mmol/l 4 6 yr f mg/dl mmol/l m mg/dL mmol/l 7 9 yr f mg/dl mmol/l m 27 96mg/dL mmol/l yr f mg/dl mmol/l m mg/dL mmol/l yr f mg/dl mmol/l m mg/dL mmol/l yr f mg/dl mmol/l m mg/dL mmol/l Adults f mg/dl mmol/l 288 m mg/dL mmol/l Iron-binding capacity, total (TIBC) Adults mg/dl mmol/l 218 Roche/Hitachi systems Unsaturated (UIBC) mg/dl mmol/l 218 Roche/Hitachi systems mg/dl mmol/l 218 COBAS INTEGRA ¾, cobas ¾ systems Lactate Adults mg/dl mmol/l 299 Venous plasma, fluoride/oxalate tubes mg/dl mmol/l Arterial plasma, fluoride/oxalate tubes <15.3 mg/dl <1.7 mmol/l Venous blood, deproteinized <11.3 mg/dl <1.3 mmol/l Arterial blood, deproteinized JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

29 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Lactate dehydrogenase (LDH) 1 d <1327 U/L <22.1 mkat/l 68 DGKC, optimized 2 5 d <1732 U/L <28.9 mkat/l 6 d 6 mth <975 U/L <16.3 mkat/l 7 12 mth <1100 U/L <18.3 mkat/l 1 3 yr <850 U/L <14.2 mkat/l 4 6 yr < 615 U/L <10.3 mkat/l 7 12 yr f <580 U/L <9.65 mkat/l m yr f m <764 U/L <436 U/L <683 U/L <12.7 mkat/l <7.25 mkat/l <11.4 mkat/l Children, adolescents <1 yr <451 U/L <7.52 mkat/l 94 IFCC 1 3 yr <344 U/L <5.73 mkat/l 4 6 yr <314 U/L <5.23 mkat/l 7 12 yr <332 U/L <5.53 mkat/l yr <279 U/L <4.65 mkat/l Adults <480 U/L <8.00 mkat/l 218, 289 DGKC, optimized, calculated with conversion factor (25 C fi 37 C) Adults >60 yr <509 U/L <8.48 mkat/l 33 SFBC method f m f m <223 U/L <232 U/L <247 U/L <248 U/L <3.72 mkat/l <3.72 mkat/l <4.12 mkat/l <4.13 mkat/l 138 IFCC, liquid Notes 238 IFCC, hospitalized patients Neonates 4 20 d <600 U/L <10.0 mkat/l 163 Standard method, 1994 Children 2 15 yr <300 U/L <5.00 mkat/l Adults f m <214 U/L <225 U/L <3.55 mkat/l <3.75 mkat/l <250 U/L <4.2 mkat/l 270 Consensus values Lead Adults 60 yr <250 mg/l <1.21 mmol/l 271 Whole blood, AAS >60 yr <320 mg/l <1.54 mmol/l Lipase Neonates <34 U/L <0.57 mkat/l 2 Colorimetric assay Children 12 yr <31 U/L <0.52 mkat/l Juveniles yr <55 U/ L <0.92 mkat/l Adults <60 U/L <1.00 mkat/l 125, 218 Colorimetric assay Lp [a] Adults <30 mg/dl <0.30 g/l 218 Immunoturbidimetric assay. Lp [a] serum concentrations in healthy persons exhibit an asymmetric distribution and may exceed 100 mg/dl (1.00 g/l). Values >30 mg/dl (0.3 g/l) are associated with higher risk of atherosclerosis JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

30 2.1 Clinical chemistry and immunological tests, serum/plasma Luteinizing hormone (LH) Analyte s References Group Conventional SI f Follicular phase mu/ml U/L 218 LH Elecsys ¾ Ovulatory phase mu/ml U/L Luteal phase mu/ml U/L Postmenopause mu/ml U/L m mu/ml IU/L Lysozyme Adults mg/l mg/l 183 a 2 -Macroglobulin Adults mg/dl g/l 237 Consensus values, CRM 470 standardization Magnesium, total Children, adolescents, newborns 5mth 6yr 7 12 yr yr mg/dl mg/dl mg/dl mg/dl mmol/l mmol/l mmol/l mmol/l 218, 299 AAS Adults yr >90 yr mg/dl mg/dl mg/dl mmol/l mmol/l mmol/l ionized mg/dl mmol/l 118 Ion-selective electrode erythrocytes mg/dl mmol/l 299 AAS Mannose binding Adults mg/l mg/l 155 protein (MBP) Mercury Adults, children <7.2 mg/l <36 nmol/l 230 Whole blood, AAS b 2 -Microglobulin Adults mg/l nmol/l 218 Immunoturbidimetric assay Myoglobin Adults f ng/ml mg/l 130, 218 Roche/Hitachi systems, m ng/ml mg/l immunoturbidimetric assay f 7 64 ng/ml 7 64 mg/l 218 COBAS INTEGRA ¾ instruments, m ng/ml mg/l immunoturbidimetric assay f ng/ml mg/l 218 Myoglobin Elecsys ¾ m ng/ml mg/l f 7 64 ng/ml 7 64 mg/l 218 Roche CARDIAC M, heparinized venous blood m ng/ml mg/l Neuron specific enolase (NSE) Healthy subjects <16.3 ng/ml <16.3 mg/l 218 NSE Elecsys ¾ Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

31 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI N-terminal pro brain natriuretic peptide (NT-proBNP) Children 1 16 yr f <83 pg/ml <9.8 pmol/l 208 Reference range shialy, probnp Elecsys ¾ m <62 pg/ml <7.3 pmol/l Adults <75 yr 75 yr Adults <45yr f m yr f m yr f m yr f m 75 yr f m 125 pg/ml 450 pg/ml <177.6 pg/ml <92.6 pg/ml <192.0 pg/ml <137.5 pg/ml <225.7 pg/ml <176.8 pg/ml <352.7 pg/ml <229.1 pg/ml <624.0 pg/ml <851.9 pg/ml 14.8 pmol/l 53.1 pmol/l <21.0 pmol/l <10.9 pmol/l <22.7 pmol/l <16.2 pmol/l <26.6 pmol/l <20.9 pmol/l <41.6 pmol/l <27.0 pmol/l <73.6 pmol/l <100.5 pmol/l Notes 85, 218 Recommended cut-off values to discriminate normal and abnormal cardiac function. 218 Reference ranges, probnp Elecsys ¾ Osmolality Neonates mosmol/kg mmol/kg 134 Adults 60 yr mosmol/kg mmol/kg >60 yr mosmol/kg mmol/kg Osteocalcin f Premenopausal <43 ng/ml <43 mg/l 218 N-MID Osteocalcin Elecsys ¾, for postmenopausal Postmenopausal <46 ng/ml <46 mg/l women under hormone replacement m <30 yr <70 ng/ml <70 mg/l therapy the ref. values for premenopausal yr <42 ng/ml <42 mg/l women are valid. >50 yr <46 ng/ml <46 mg/l P1NP f Postmenopausal on HRT ng/ml mg/l 218 P1NP Elecsys ¾ no HRT ng/ml mg/l Premenopausal ng/ml mg/l Pancreatic elastase Adults <3.8 ng/ml <3.8 ng/ml JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

32 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Group Conventional SI Parathyrin, Parathyroid hormone (PTH) Phosphate, inorganic Phosphohexose isomerase (PHI) 2 4 yr f ng/l pmol/l 45 m ng/l pmol/l 5 6 yr f ng/l pmol/l m ng/l pmol/l 7 8 yr f ng/l pmol/l m ng/l pmol/l 9 10 yr f ng/l pmol/l m ng/l pmol/l yr f ng/l pmol/l m ng/l pmol/l yr f ng/l pmol/l m ng/l pmol/l yr f ng/l pmol/l m ng/l pmol/l 3 51 ng/l pmol/l 250 Chemiluminescence immunoassay Adults ng/l pmol/l ng/l pmol/l 218 PTH Elecsys ¾ Children, adolescents 1 30 d mg/dl mmol/l mth mg/dl mmol/l 1 3 yr mg/dl mmol/l 4 6 yr mg/dl mmol/l 7 9 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l Adults mg/dl mmol/l mg/dl mmol/l U/L mkat/l 239 Potassium Adults meq/l mmol/l 218, 299 Roche Diagnostics, indirect ISE, serum f m meq/l meq/l mmol/l mmol/l flame photometry, plasma Children 1 7 d meq/l mmol/l 247 Plasma, dry slide technology 8 31 d meq/l mmol/l 1 6 mth meq/l mmol/l 7 mth 1 yr meq/l mmol/l >1 yr meq/l mmol/l Adults meq/l mmol/l 218 COBAS INTEGRA ¾, direct ISE, serum meq/l mmol/l COBAS INTEGRA ¾, direct ISE, plasma meq/l mmol/l 218 Reflotron ¾, serum meq/l mmol/l Reflotron ¾, plasma Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

33 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Prealbumin Children <1 mth 7 39 mg/dl g/l 54 Immunonephelometry, (Transthyretin) 1 6 mth 8 34 mg/dl g/l CRM 470 standardization 7 mth 6 yr mg/dl g/l Adults mg/dl g/l 237 Pregnancy-associated plasma protein A (PAPP-A) Healthy non-pregnant donors <7.15 miu/l <7.15 miu/l 218 PAPP-A Elecsys ¾, Roche study no. R04P026 Procalcitonin <0.5 ng/ml <0.5 mg/l 176 Progesterone w Follicular phase ng/ml nmol/l 218 Progesterone II Elecsys ¾ Ovulatory phase ng/ml nmol/l Luteal phase ng/ml nmol/l Postmenopause ng/ml nmol/l m ng/ml nmol/l Prolactin Children, adolescents f ng/ml mg/l 49 Chemiluminescence immunoassay m ng/ml mg/l 1 12 mth f ng/ml mg/l m ng/ml mg/l 1 3 yr f ng/ml mg/l m ng/ml mg/l 4 6 yr f ng/ml mg/l m ng/ml mg/l Conversion of ng/ml to mu/l depends 7 9 yr f ng/ml mg/l on the type of standard used m ng/ml mg/l yr f ng/ml mg/l m ng/ml mg/l yr f ng/ml mg/l m ng/ml mg/l yr f ng/ml mg/l m ng/ml mg/l Adults f ng/ml mu/l 218 Prolactin Elecsys ¾ m ng/ml mu/l Prostate specific m <40 yr <1.4 ng/ml <1.4 mg/l 218 PSA Elecsys ¾ antigen, total yr <2.0 ng/ml <2.0 mg/l (tpsa) yr <3.1 ng/ml <3.1 mg/l yr <4.1 ng/ml <4.1 mg/l >70 yr <4.4 ng/ml <4.4 mg/l free PSA/total PSA > Free PSA Elecsys ¾, probability of ratio (fpsa/tpsa) m yr 49.2 % 26.9 % 18.3 % 9.1 % finding prostate cancer by age in years yr 57.5 % 33.9 % 23.9 % 12.2 % 70 yr 64.5 % 40.8 % 29.7 % 15.8 % JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

34 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Protein, total Children, adolescents 1 w g/dl g/l 218, mth 12 mth g/dl g/l 1 2 yr g/dl g/l >3 yr g/dl g/l Newborns g/dl g/l Premature g/dl g/l Umbilical cord g/dl g/l Adults g/dl g/l Electrophoresis Albumin % Ponceau Red S a 1 -Globulin % a 2 -Globulin % b-globulin % g-globulin % Pyruvate Adults mg/dl mmol/l 152 Whole blood, deproteinize immediately using ice-cold perchloric acid. Rheumatoid factor (RF) S100 Adults <14 IU/mL <14 kiu/l 218 Immunoturbidimetric method, Roche Diagnostics Apparently healthy mg/l mg/l 218 S100 Elecsys ¾ adults Selenium mg/l mmol/l 150 Whole blood mg/l mmol/l Plasma Sexual hormone f yr nmol/l nmol/l 218 SHBG Elecsys ¾, binding globulin (SHBG) Postmenopausal, untreated nmol/l nmol/l free testosterone/androgen index: see package insert. m yr nmol/l nmol/l Sodium Children < 7 d meq/l mmol/l 247 Indirect ISE 8 d 1 mth meq/l mmol/l 2 6 mth meq/l mmol/l 7 m 1 yr meq/l mmol/l >1 yr meq/l mmol/l Adults 90 yr meq/l mmol/l 299 Flame emission photometry, indirect ISE >90 yr meq/l mmol/l Adults meq/l mmol/l 218 COBAS INTEGRA ¾, direct ISE Sorbitol mg/dl mmol/l 28 Plasma, deproteinize immediately. Squamous cell carcinoma antigen (SCC) <2.0 ng/ml <20 mg/l 299 Freeze sample immediately JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

35 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Testosterone Children, adolescents, m <1 yr ng/ml nmol/l 218 Testosterone Elecsys ¾ 1 6 yr ng/ml nmol/l 7 12 yr ng/ml nmol/l yr ng/ml nmol/l Adults f ng/ml nmol/l m ng/ml nmol/l Thallium <5 mg/l <24 nmol/l 299 Whole blood, AAS Thyroglobulin Children, adolescents Newborns ng/ml mg/l 219 Thyroglobulin ElecsysÐ*, reference range study 6 d 3 mth ng/ml mg/l 4 12 mth ng/ml mg/l 1 6 yr ng/ml mg/l 7 11 yr ng/ml mg/l yr ng/ml mg/l Healthy subjects ng/ml mg/l 218 Thyroglobulin Elecsys ¾ Thyroid stimulating hormone (TSH) Thyroxine (T 4 ) Children, adolescents Newborns mu/ml mu/l 219 TSH Elecsys ¾, reference range study 6 d 3 mth mu/ml mu/l 4 12 mth mu/ml mu/l 1 6 yr mu/ml mu/l 7 11 yr mu/ml mu/l yr mu/ml mu/l Healthy blood donors mu/ml mu/l 146 TSH Elecsys ¾, group selected acc. to National Academy of Clinical Biochemistry (NACB) recommendations Healthy subjects mu/ml mu/l 218 TSH Elecsys ¾ Children, adolescents Newborns mg/dl nmol/l 219 T 4 Elecsys ¾, reference range study 6 d 3 mth mg/dl nmol/l 4 12 mth mg/dl nmol/l 1 6 yr mg/dl nmol/l 7 11 yr mg/dl nmol/l yr mg/dl nmol/l Adults mg/dl nmol/l 218 T 4 Elecsys ¾ Healthy blood donors mg/dl nmol/l 146 T 4 Elecsys ¾, group selected acc. to NACB recommendations Adults 4 12 mg/dl nmol/l 218 Roche Diagnostics, fluorescence polarization immunoassay Adults mg/dl nmol/l 218 Roche Diagnostics, homogeneous enzyme immunoassay JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

36 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Thyroxine-binding , 219 T-uptake Elecsys ¾ capacity (as TBI) Transferrin Adults g/l mmol/l 89, 218, Immunoturbidimetric assay, 237 CRM 470 standardization Transferrin, carbohydrate deficient (as % CDT) Transferrin receptor, soluble (stfr) Adults 3.0 % 3.0 % 218 Roche Diagnostics, immunoturbidimetric assay, elevated values indicate alcohol misuse mth mg/l mg/l 144 Enzyme immunoassay 2 6 yr mg/l mg/l 7 12 yr mg/l mg/l 18 yr mg/l mg/l Adults f yr mg/l nmol/l 141 Roche Diagnostics, immunoturbidimetric assay m yr mg/l nmol/l Transferrin % % 262 TS [%] = Fe [mg/dl] q 70.9/Transferrin [mg/dl] saturation (TS) Triglycerides Premature <62 mg/dl <0.7 mmol/l 78 Adults 65 yr <200 mg/dl <2.3 mmol/l 65, 218 >65 yr <325 mg/dl <3.7 mmol/l 33 <150 mg/dl <1.7 mmol/l 46 Cutpoint acc. to NECP ATP III Triiodothyronine (T 3 ) Children, adolescents Newborns ng/ml nmol/l 219 T 3 Elecsys ¾, reference range study 6 d 3 mth ng/ml nmol/l 4 12 mth ng/ml nmol/l 1 6 yr ng/ml nmol/l 7 11 yr ng/ml nmol/l yr ng/ml nmol/l Adults, euthyroid ng/ml nmol/l 218 T 3 Elecsys ¾ Troponin I Adults 0.16 ng/ml 0.16 mg/l 15, 22 Chemiluminescence immunoassay, Troponin I Elecsys ¾ Neonates ng/ml mg/l 22 Enzyme immunoassay Troponin T Children < 7 d 0.35 ng/ml 0.35 mg/l 165 Troponin T Elecsys ¾ 8 30 d 0.20 ng/ml 0.20 mg/l d 0.1 ng/ml 0.1 mg/l 121 d 1 yr 0.03 ng/ml 0.03 mg/l Neonates ng/ml mg/l 22 Troponin T Elecsys ¾ Healthy volunteers <0.01 ng/ml <0.01 mg/l 218 Troponin T Elecsys ¾ 0.1 ng/ml 0.1 mg/l 218 Cut-off acc. to WHO criteria Adults <0.03 ng/ml < 0.03 mg/l 132 Roche CARDIAC T JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

37 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI T-uptake Blood donors % Roche Diagnostics, homogeneous enzyme (free thyroxine immunoassay binding capacity) Urea Children 1 3 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l Adults mg/dl mmol/l f, <50 yr mg/dl mmol/l f, >50 yr mg/dl mmol/l m, <50 yr mg/dl mmol/l m, >50 yr mg/dl mmol/l Adults f yr mg/dl mmol/l 227 NORIP 50 yr mg/dl mmol/l m yr mg/dl mmol/l 50 yr mg/dl mmol/l Uric acid Children f 1 30 d mg/dl mmol/l d mg/dl mmol/l 1 3 yr mg/dl mmol/l 4 6 yr mg/dl mmol/l 7 9 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l m 1 30 d mg/dl mmol/l d mg/dl mmol/l 1 3 yr mg/dl mmol/l 4 6 yr mg/dl mmol/l 7 9 yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l yr mg/dl mmol/l Adults f mg/dl mmol/l Recommended upper limit of males: 7 mg/dl m mg/dl mmol/l (416 mmol/l) f mg/dl mmol/l 218 Roche/Hitachi, COBAS INTEGRA ¾, cobas ¾, m mg/dl mmol/l Reflotron ¾ systems Adults f yr mg/dl mmol/l 227 NORIP 50 yr mg/dl mmol/l m 18 yr mg/dl mmol/l JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

38 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Vitamin A 15 yr f mg/dl mmol/l 110 HPLC (Retinol) m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l >60 yr f mg/dl mmol/l m mg/dl mmol/l Vitamin B mg/dl 5 28 nmol/l 293 HPLC, serum (Thiamine) mg/dl nmol/l HPLC, whole blood Vitamin B mg/dl mmol/l 299 HPLC, fluorimetry (Riboflavin) Vitamin B 6 (Pyridoxal mg/dl nmol/l 21 HPLC phosphate) Vitamin B 12 <1 yr f pg/ml pmol/l 109 RIA m pg/ml pmol/l 2 3 yr f pg/ml pmol/l m pg/ml pmol/l 4 6 yr f pg/ml pmol/l m pg/ml pmol/l 7 9 yr f pg/ml pmol/l m pg/ml pmol/l yr f pg/ml pmol/l m pg/ml pmol/l yr f pg/ml pmol/l m pg/ml pmol/l Adults Europe USA pg/ml pg/ml pmol/l pmol/l 218 Vitamin B 12 Elecsys ¾ Vitamin C Adults mg/dl mmol/l 57 Vitamin D 3, 25-OH Children, adults ng/ml nmol/l 21 Approximate reference range based on three studies. Healthy individuals ng/ml nmol/l 250 Chemiluminescence assay Adults ng/ml nmol/l 218 Vitamin D 3 Elecsys ¾, Roche Diagnostics, population-based reference range, Germany, summer time Children. adults >30 ng/ml >75 nmol/l 280 Health-based reference range JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

39 2.1 Clinical chemistry and immunological tests, serum/plasma Analyte s References Notes Group Conventional SI Vitamin E <15 yr f mg/dl mmol/l 110 EDTA plasma, HPLC (a-tocopherol) m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l yr f mg/dl mmol/l m mg/dl mmol/l >60 yr f mg/dl mmol/l m mg/dl mmol/l Vitamin K Adults mg/l nmol/l 21 HPLC, fasting Zinc <4 mth mg/dl mmol/l mth mg/dl mmol/l 1 5 yr mg/dl mmol/l 6 9 yr mg/dl mmol/l yr f mg/dl mmol/l m 78 98mg/dL mmol/l yr f mg/dl 9 15 mmol/l m mg/dL mmol/l Zinc protoporphyrin Adults mg/dl 7 23 mmol/l 150 Plasma mg/dl mmol/l Whole blood mg/l mmol/l 299 Whole blood (heparine EDTA), hematofluorimetric test JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

40 2.2 Hematology Analyte s References Notes Goup Conventional SI CO-Hb Non-smokers <2.2 % < Smokers <10.5 % <0.105 Differential leucocyte count Band neutrophils Infants <8 % < Blood must be smeared within 3 hours (93) Children 3 6 % Adults 3 5 % Segmented Infants % neutrophils Children % Adults % Eosinophils Infants 1 5 % Children 1 5 % Adults 2 4 % Basophils Infants <1 % <0.01 Children <1 % <0.01 Adults <1 % <0.01 Monocytes Infants 1 11 % Children 1 6 % Adults 2 8 % Lymphocytes Infants % Children % Adults % Eosinophiles mil/ml mpt/l 25 Erythrocytes 1 d mil/ml tpt/l d mil/ml tpt/l d mil/ml tpt/l d mil/ml tpt/l d mil/ml tpt/l mth mil/ml tpt/l mth mil/ml tpt/l 5 7 mth mil/ml tpt/l 8 mth-3 yr mil/ml tpt/l 5 yr mil/ml tpt/l 10 yr mil/ml tpt/l Adults f mil/ml tpt/l 294 m mil/ml tpt/l Erythrocyte sedimentation rate (ESR) Adults 50 yr Adults >50 yr f m f m <25 mm/1 h <15 mm/1 h <30 mm/1 h <20 mm/1 h <25 mm/1 h <15 mm/1 h <30 mm/1 h <20 mm/1 h 56 Citrated blood JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

41 2.2 Hematology Analyte s References Notes Group Conventional SI Glucose-6-phosphate dehydrogenase (G-6-P-DH) U/g Hb mu/mol Hb 299 Blood treated with heparinate or EDTA, 37 C Hematocrit 1 d % (Hct, PCV) 2 6 d % d % d % d % mth % mth % mth % mth 3 yr % yr % yr % Adults f % m % Hemoglobin (Hb) 1 d g/dl mmol/l 122 in blood 2 6 d g/dl mmol/l d g/dl mmol/l d g/dl mmol/l d g/dl mmol/l mth g/dl mmol/l mth g/dl mmol/l 5 7 mth g/dl mmol/l 8 10 mth g/dl mmol/l mth g/dl mmol/l yr g/dl mmol/l 5 yr g/dl mmol/l 10 yr g/dl mmol/l Adults f g/dl mmol/l 294 m g/dl mmol/l >70 yr f g/dl mmol/l 189 m g/dl mmol/l >75 yr f g/dl mmol/l m >81 yr f m g/dl g/dl g/dl mmol/l mmol/l mmol/l Hb composition HbA % HbA % HbA % HbF % JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

42 2.2 Hematology Analyte s References Group Conventional SI Leucocytes 12 h 13,000 38,000/mL gpt/l 56 1 d 9,400 34,000/mL gpt/l 1 w 5,000 21,000/mL gpt/l 2 w 5,000 20,000/mL gpt/l 4 w 5,000 19,500/mL gpt/l 2 mth 5,500 18,000/mL gpt/l 4 12 mth 6,000 17,500/mL gpt/l 2 yr 6,000 17,000/mL gpt/l 4 yr 5,500 15,500/mL gpt/l 6 yr 5,000 14,500/mL gpt/l 8 12 yr 4,500 13,500/mL gpt/l yr 4,500 13,000/mL gpt/l 18 yr 4,500 12,500/mL gpt/l 20 yr 4,500 11,500/mL gpt/l Adults 4,400 11,300/mL gpt/l 294 MCH (Hb/RBC) 1 d pg/cell fmol/cell d pg/cell fmol/cell d pg/cell fmol/cell d pg/cell fmol/cell mth pg/cell fmol/cell mth pg/cell fmol/cell 5 10 mth pg/cell fmol/cell 11 mth 5 yr pg/cell fmol/cell 10 yr pg/cell fmol/cell Adults pg/cell fmol/cell 294 MCHC 1 d g/dl mmol/l d g/dl mmol/l d g/dl mmol/l d g/dl mmol/l 40 d 7 mth g/dl mmol/l mth g/dl mmol/l yr g/dl mmol/l 5 10 yr g/dl mmol/l Adults g/dl mmol/l 294 Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

43 2.2 Hematology Analyte s References Notes Group Conventional SI MCV 1 d mm fl d mm fl d mm fl d mm fl mth mm fl mth mm fl 5 7 mth mm fl 8 10 mth mm fl mth mm fl yr mm fl 5yr 72 88mm fl 10 yr mm fl Adults mm fl 294 Methemoglobin Non-smokers/smokers <1.2 % < Osmotic resistance No hemolysis >0.5 % NaCl >0.005 NaCl 56 Heparinized blood of erythrocytes Complete hemolysis <0.3 % NaCl <0.003 NaCl Pyruvate kinase in U/g Hb mu/mol Hb 71 Heparinized or EDTA blood erythrocytes Reticulocytes 1 d q d q d <10 <10 q mth q mth q mth q mth q mth q 10 3 >4 mth q 10 3 Reticulocyte hemoglobin equivalent (RET-H e ) Adults q Adults pg pg 269 Derived from Ret-Y as determined on a Sysmex XE 2100 hematology analyzer JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

44 2.2 Hematology Analyte s References Group Conventional SI Thrombocytes 1 5 yr f q 10 3 /ml Gpt/L 80 m q 10 3 /ml Gpt/L 6 10 yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L >70 yr f q 10 3 /ml Gpt/L m q 10 3 /ml Gpt/L Volume Blood f ml/kg L/kg 56 m ml/kg L/kg Erythrocytes f ml/kg L/kg m ml/kg L/kg Plasma f ml/kg L/kg m ml/kg L/kg Notes JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

45 2.3 Coagulation Analyte s References Notes Group Conventional SI Antiphospholipid antibodies (APA) No antibodies No antibodies 273 ELISA, Asserachrom ¾ *APA a 2 -Antiplasmin 2 10 yr % yr % Adults % Photometric assay Full-term infants 1 d U/mL U/mL 4 5 d U/mL U/mL 30 d U/mL U/mL 90 d U/mL U/mL 180 d U/mL U/mL Adults U/mL U/mL Antithrombin III Infants, premature 1 d % d % d % Infants, full-term 1 d % d % Children 2 10 yr >67 % > yr >81 % >0.81 Adults >80 % > Activity test, chromogenic substrate Bleeding time 1 5 yr <10 min <10 min 13 Modification of the method according to Mielke 6 10 yr <13 min <13 min yr <8 min <8 min Adults <7 min <7 min C4bBP 1 d <66 % < w 2 mth % mth % mth % mth % Adults % D-Dimer 1 6 yr < 0.6 mg/ml < 0.6 mg/l 215 ELISA 7 12 yr < 0.5 mg/ml < 0.5 mg/l yr < 0.7 mg/ml < 0.7 mg/l Pregnancy <20 w <2.2 mg/ml <2.2 mg/l w <4.3 mg/ml <4.3mg/L Adults <0.5 mg/ml <0.5 mg/l 218 Enzyme immunoassay <0.5 mg/ml < 0.5 mg/l 218 Immunoturbidimetric assays, Roche CARDIAC D-Dimer * Asserachrom is a trademark of Diagnostica STAGO JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

46 2.3 Coagulation Analyte s References Notes Group Conventional SI Factor II Neonates 31 59% Adults >70% > Factor V Neonates % Adults >70% > Factor VII Neonates % yr f % m % yr f % m % Adults >70 % > % Factor VIII 2 10 yr % yr % Adults >70 % > Adults % Factor IX Neonates 11 55% yr 60 98% Adults >60% >0.60 Factor X Neonates 24 45% Adults >70% > , 218 Factor XI 1 16 yr % Adults >70 % > Adults % Factor XII 1 16 yr % Newborns have approx. 50 % of the adult value Adults >60 % > , 218 Factor XIII Adults >60 % > Fibrin monomers Adults <20 mg/ml <20 mg/l 154 Agglutination test JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

47 2.3 Coagulation Analyte s References Notes Group Conventional SI Fibrinogen Infants, premature 1 d mg/dl g/l 12 5 d mg/dl g/l 1 mth mg/dl g/l 3 mth mg/dl g/l 6 mth mg/dl g/l Infants, full-term 1 d mg/dl g/l 11 5 d mg/dl g/l 1 mth mg/dl g/l 3 mth mg/dl g/l 6 mth mg/dl g/l 2 10 yr mg/dl g/l yr mg/dl g/l Adults mg/dl g/l 218 Fibrinogen levels increase during pregnancy Fibrin(ogen) degradation products (FDP) Adults <10 mg/ml <10 mg/l 251 Fibrinopeptide A <3 mg/ml <3 mg/l 7 Enzyme immunoassay Fibronectin Adults <300 mg/l <0.3 g/l 20 Heparin cofactor II Adults >60 % > Hepato Quick Children >50 % > Citrated plasma, citrated blood, whole blood Adults >70 % >0.70 High molecular 1 16 yr % weight kininogen (HMWKG) Adults >70 % > International normalized ratio (INR) Atrial fibrillation/flutter INR When determining the INR the bleeding Valvular defects INR and thrombosis risk has to be considered individually for each patient. Valve replacements a) Mechanical valves INR Bileaflet valves/tilting disc valves in aortic position in mitral position INR Caged Ball valves INR Mechanical valve + embolism INR b) Bioprosthetic valves INR For 3 months Deep vein thrombosis/pulmonary embolism INR JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

48 2.3 Coagulation Analyte s References Notes Group Conventional SI a 2 -Macroglobulin Full-term infants 1 d U/mL U/mL 4 5 d U/mL U/mL 1 mth U/mL U/mL 3 mth U/mL U/mL 6 mth U/mL U/mL Adults U/mL U/mL (Activated) Partial Premature infants 1 d <79 s <79 s 12 Values are reagent- and age-dependent. thromboplastintime 5 d <74 s <74 s (PTT, APTT) 1 mth <63 s <63 s 3 mth <51 s <51 s 6 mth <53 s <53 s Full-term infants 1 d <55 s <55 s 11 5 d <60 s <60 s 1 mth <55 s <55 s 3 mth <50 s <50 s 6 mth <43 s <43 s 2 10 yr <43 s <43 s 283 Neothromtin Adults <38 s <38 s 2 10 yr <42 s <42 s Actin FS Adults <40 s <40 s Adults s s 218 Kaolin-activated APTT Plasmin-a 2 -anti- 1 6 yr mg/l mg/l 215 plasmin complex 7 12 yr mg/l mg/l yr mg/l mg/l Adults mg/l mg/l Plasminogen Neonates % yr % yr % Adults >70 % > Colorimetric test Full-term infants 1 d U/mL U/mL 4 5 d U/mL U/mL 1 mth U/mL U/mL 3 mth U/mL U/mL 6 mth U/mL U/mL Adults U/mL U/mL JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

49 2.3 Coagulation Analyte s References Group Conventional SI Plasminogen activator inhibitor (PAI) Platelet factor 4 (PF4) Notes <10 AU/mL <10 kau/l 48 Colorimetric test, AU = arbitrary unit Full-term infants 1 d U/mL U/mL 4 5 d <8.1 U/mL <8.1 U/mL 1 mth <8.8 U/mL <8.8 U/mL 3 mth U/mL U/mL 6 mth U/mL U/mL Adults < 11.0 U/mL < 11.0 U/mL <5 U/mL <5 ku/l 9 Enzyme immunoassay, CTAD collection tubes Prekallikrein 1 16 yr % Adults >50 % > Protein C Neonates U/mL ku/l 202 Antigen concentration 2 10 yr % yr % Adults % Protein C concentration, enzyme immunoassay Adults % Protein C activity, chromogenic method and clotting test Activity/antigen 1 d concentration ratio 2 d d d mth Protein S, total 1 d % Concentration: Enzyme immunoassay. 1 w 2 mth % In pregnancy often low values. 3 4 mth % After the first centrifugation step, the plasma 5 6 mth % must be centrifuged a second time and 7 12 mth % separated from cells, immediately freeze the supernatant. Adults % Protein S, free 1 d % w 2 mth % mth % mth % mth % Adults f % Clotting test m % JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

50 2.3 Coagulation Analyte s References Notes Group Conventional SI Prothrombin 1 6 yr nmol/l nmol/l 215 Enzyme immunoassay fragments yr nmol/l nmol/l yr nmol/l nmol/l Adults nmol/l nmol/l Prothrombin time (PT) 6mth 5yr 6yr 7yr 8 16 yr % % % Therapeutic range in percent is method dependent and corresponds to INR: Values >100 % are of no clinical significance. Adults >70 % > Reptilase time Adults <20 s <20 s 290 Thrombin AT III 1 6 yr mg/l mg/l 215 Enzyme immunoassay complex (TAT) 7 12 yr mg/l mg/l yr mg/l mg/l Adults mg/l mg/l Thrombin coagulase Adults <23 s <23 s 290 Thrombin time Premature infants 1 d <30 s <30 s 12 5 d <29 s <29 s 1 mth <30 s <30 s 3 mth <31 s <31 s 6 mth <32 s <32 s Neonates 1 d <28 s <28 s 11 5 d <29 s <29 s 1 mth <29 s <29 s 3 mth <30 s <30 s 6 mth <31 s <31 s Adults <22 s <22 s 20 Normal range: 21 s Ctrl. of heparin therapy: 13 s Normal range: 21 s Ctrl. of heparin therapy: 13 s b-thromboglobulin Adults <40 U/mL <40 ku/l 9 Enzyme immunoassay, plasma. Urine: approx. 0.5 % of plasma value. Tissue factor pathway inhibitor Adults >70 % > 0, JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

51 2.3 Coagulation Analyte s References Group Conventional SI Tissue plasminogen activator (t-pa) <12 ng/ml <12 mg/l 20 t-pa levels increase with age, smoking, physical exercise, stress. Venous stasis induces an increase of t-pa levels. Adults 1 12 ng/ml 1 12 mg/l 218 Enzyme immunoassay Notes von Willebrand factor (vwf) Full-term infants 1 d ng/ml mg/ml 4 5 d ng/ml mg/l 30 d ng/ml mg/l 3 mth ng/ml mg/l 6 mth ng/ml mg/l Adults ng/ml mg/l 2 10 yr % Adults % Enzyme immunoassay, lower results with blood group JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

52 2.4 Blood gases Analyte s References Notes Group Conventional SI Base excess Adults 2 to + 3 mmol/l 2 to + 3 mmol/l 184 Blood, arterial, venous O 2 -saturation Adults % Blood, arterial % Blood, venous pco 2 Children A. umb mm Hg kpa 184 Blood V. umb mm Hg kpa Children 1 d mm Hg kpa 10 d 3 mth mm Hg kpa 4 12 mth mm Hg kpa Adults w mm Hg kpa m mm Hg kpa ph Children A. umb Blood V. umb Children 1 d d 3 mth mth Adults Blood, arterial Blood, mixed venous po 2 Children A. umb. < 22 mm Hg < 2.9 kpa 184 Blood V. umb mm Hg kpa 10 d 3 mth mm Hg kpa Adults mm Hg kpa Blood, arterial mm Hg kpa Blood, mixed venous Standard bicarbonate Children V. umb mmol/l mmol/l 184 Blood Children 1 d mmol/l mmol/l 10 d 3 mth mmol/l mmol/l 4 12 mth mmol/l mmol/l Adults mmol/l mmol/l mmol/l mmol/l Serum, plasma JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

53 2.5 Therapeutic drug monitoring Analyte Therapeutic Range* Reference Notes Group Conventional SI Acetaminophene mg/ml mmol/l 218 Immunoturbidimetric assay, Roche Diagnostics Acetylsalicylic acid mg/ml mmol/l 193 Blood collection: 1 3 h after oral dose. Amikacin Peak: mg/ml Trough: 5 10 mg/ml mmol/l 9 17 mmol/l 218 Fluorescence polarization immunoassay, immunoturbidimetric immunoassay, Roche Diagnostics Benzodiazepine <200 mg/ml <200 mg/l 218 Immunoturbidimetric assay, Roche Diagnostics, laboratory-dependent cutoff in urine. Caffeine 5 20 mg/ml mmol/l 193 Carbamazepine 8 12 mg/ml mmol/l 218 Homogeneous enzyme immunoassay, immunoturbidimetric assay, Roche Diagnostics 6 12 mg/ml mmol/l Fluorescence polarization immunoassay, Roche Diagnostics Chloramphenicol mg/ml mmol/l 193 Cyclosporine No firm therapeutic range exists. Range must be established 218 Whole blood for the specific assay used. Digitoxin ng/ml nmol/l 218 Fluorescence polarization immunoassay, turbidimetric immunoassay, electrochemiluminescence immunoasay, Roche Diagnostics Digoxin ng/ml nmol/l 218 Electrochemiluminescence immunoassay, homogeneous enzyme immunoassay, Roche Diagnostics ng/ml nmol/l Fluorescence polarization immunoassay, immunoturbidimetric immunoassay, Roche Diagnostics Disopyramide 2 5 mg/ml 6 15 mmol/l 193 Ethosuximide mg/ml mmol/l 193 Gentamicin Peak: 6 10 mg/ml Trough: mg/ml Peak: 6 10 mg/ml Trough: mg/ml mmol/l mmol/l mmol/l mmol/l 218 Fluorescence polarization immunoassay, immunoturbidimetric immunoassay, Roche Diagnostics Homogeneous enzyme immunoassay, Roche Diagnostics Lidocaine mg/ml 6 26 mmol/l 218 Fluorescence polarization immunoassay, Roche Diagnostics, blood collection: during infusion Lithium meq/l mmol/l 218 Colorimetric assay, direct ISE, Roche Diagnostics, blood collection: 12 h after final dose * The therapeutic range given is a general recommendation which can only be clinically interpreted in conjunction with the toxicity and the therapeutic efficacy of the drug monitored JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

54 2.5 Therapeutic drug monitoring Analyte Therapeutic Range* References Group Conventional SI Methotrexate A generally applicable therapeutic range is not available. Mycophenolic acid, total (MPA) N-Acetytylprocainamide (NAPA) Therapeutic range not yet fully established and dependent Therapeutic concentrations depend on the treatment protocol. on transplant type and co-administered drugs. Notes 299 Collect specimen at 0.5 or 2 h after i.v. or p.o. low dose, respectively. Collect specimen at 24, 48, and 72 h after high-dose infusion mg/ml mmol/l 218 Immunoturbidimetric assay, homogeneous immunoassay, fluorescence polarization immunoassay, Roche Diagnostics; commonly accepted therapeutic range for the sum of NAPA and procainamide. For effective treatment, some patients may require serum/plasma levels outside thise range. Phenobarbital mg/ml mmol/l 218 Immunoturbidimetric assay, homogeneous immunoassay, fluorescence polarization immunoassay, Roche Diagnostics; some patients may require serum/plasma levels outside thise range to obtain effective seizure control. Phenytoin Premature infants Adults 6 14 mg/ml approx mg/ml mmol/l approx mmol/l Immunoturbidimetric assay, homogeneous immunoassay, fluorescence polarization immunoassay, Roche Diagnostics. Primidone 5 12 mg/ml mmol/l 218 Fluorescence polarization immunoassay, Roche Diagnostics. Procainamide 4 10 mg/ml mmol/l 218 Immunoturbidimetric assay, homogeneous immunoassay, fluorescence polarization immunoassay, Roche Diagnostics. Quinidine mg/ml mmol/l 218 Thrapeutic ranges established with unspecific methods that measure quinidine as well as quinidine metabolites. Salicylic acid mg/ml mg/ml mmol/l mmol/l Tacrolimus 5 20 ng/ml (trough) 4 16 mmol/l (trough) Antipyretic/analgetic conditions. Anti-inflammatory/rheumatic fever conditions. Colorimetric assay, enzymatic UV test; Roche Diagnostics. * The therapeutic range given is a general recommendation which can only be clinically interpreted in conjunction with the toxicity and the therapeutic efficacy of the drug monitored JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

55 2.5 Therapeutic drug monitoring Analyte Therapeutic Range* References Notes Group Conventional SI Theophylline approx mg/ml approx mmol/l 218 Homogeneous immunoassay, fluorescence immunoassay, immunoturbidimetric assay, Roche Diagnostics. Tobramycin Peak: 6 10 mg/ml Trough: mg/ml Peak: mmol/l Trough: mmol/l 218 Homogeneous immunoassay, fluorescence immunoassay, Roche Diagnostics Valproic acid mg/ml mmol/l 218 Homogeneous immunoassay, fluorescence free fraction 5 15 % of the plasma value of the plasma value immunoassay, Roche Diagnostics Fluorescence immunoassay, Roche Diagnostics Vancomycin Peak: mg/ml Trough: 5 10 mg/ml Peak: mmol/l Trough: mmol/l 218 Homogeneous immunoassay, fluorescence immunoassay, Roche Diagnostics * The therapeutic range given is a general recommendation which can only be clinically interpreted in conjunction with the toxicity and the therapeutic efficacy of the drug monitored JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

56 2.6.1 Urinalysis, urinary sediment and status Analyte s References Notes Group Conventional SI Bacteria Children <10 3 /ml <10 9 /L 218 Chamber count Adults <10 5 /ml <10 11 /L Specific gravity Neonates g/ml g/ml 218 Daily urine, normal diet Children g/ml g/ml Adults g/ml g/ml Urinary sediment Erythrocytes 0 1 per field (<5/mL) 0 1 per field (<5 Mpt/L) 214 Group classification per field (magnification q 400): Not detectable >50 Crowding Leucocytes 1 4 per field (<10/mL) 1 4 per field (<10 Mpt/L) Squamous epithelial cells 5 15 per field 5 15 per field Renal epithelial cells Not detectable Not detectable Casts hyaline Only occasional Only occasional epithelial Not detectable Not detectable erythrocyte Not detectable Not detectable granulated Not detectable Not detectable leucocyte Not detectable Not detectable Bacteria Not detectable Not detectable Yeast cells Not detectable Not detectable Trichomonads Not detectable Not detectable Salts Not detectable Not detectable Group classification per field (magnification q 400): Not detectable (+) Crowding JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

57 2.6.1 Urinalysis, urinary sediment and status Analyte s References Notes Group Conventional SI Urinary status Bilirubin <0.2 mg/dl <3.4 mmol/l 218 Combur 10 Test ¾ Erythrocytes <5/mL <5 Mpt/L Glucose <15 mg/dl <0.84 mmol/l Fasting Ketone bodies (acetacetate) <5 mg/dl <0.5 mmol/l Leucocytes <10/mL <10 Mpt/L Nitrite Not detectable Not detectable ph Protein <10 mg/dl <0.1 g/l Specific gravity g/ml Urobilinogen <1 mg/dl <16.9 mmol/l Urine volume Neonates ml/24 h L/d 47 Normal liquid intake 2 mth 1 yr ml/24 h L/d 2 3 yr ml/24 h L/d > 10 yr ml/24 h L/d Adults ml/24 h L/d JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

58 2.6.2 Clinical chemical urinalysis Analyte s References Group Conventional SI a 1 -Acid glycoprotein (Orosomucoid) Adenosine monophosphate, 3l 5l, cycl. 1 mth 15 yr <4.4 mg/g crea <0.5g/mol crea 112 Radial immunodiffusion, spontaneously voided urine. Adults <1.6 mg/g crea <560 mmol/mol crea 275 Deep-freeze immediately Albumin Children <1 mth <252 mg/l <21 mg/mmol crea 112 Spontaneously voided urine, radial 1 12 mth <12.3 mg/l <3.8 mg/mmol crea immunodiffusion 1 5 yr <19.0 mg/l <3.3 mg/mmol crea 6 10 yr <30.4 mg/l <2.7 mg/mmol crea yr <25.5 mg/l <2.1 mg/mmol crea Adults <20 mg/g crea or <2.26 g (34.35 mmol)/mol crea 218 2nd morning urine Children 3 5 yr <20 mg/l or <37 mg/g or <0.304 mmol/l or 24 h-urine <2 mg/dl or <30 mg/24 h <0.304 mmol/l or <0.456 mmol/d Immunoturbidimetric assay, Roche Diagnostics d-aminolevulicacid Adults <6.4 mg/24 h <49 mmol/d 60 24h-urinetobeacidifiedwithHCI, ph2 3 a-amylase, total Adults f m pancreatic Adults f m 447 U/L 491 U/L 390 U/g crea 283 U/g crea 7.46 mkat/l 8.20 mkat/l 6.51 mkat/g crea 4.73 mkat/g crea Notes 218 Spontaneously voided urine Amylase/creatinine quotient Calcium Children <6 mg/kg/24 h <0.15 mmol/kg/d h-urine, acidified (ph <2) with HCl Adults f <260 mg/24 h <6.5 mmol/d m <320 mg/24 h <8.0 mmol/d mg/24 h or mg/dl mmol/d or mmol/l h-urine (assumed volume: 1.5 L) Carnitin, free Neonates mmol/24 h mmol/d 242 Infants mmol/24 h mmol/d Adults mmol/24 h mmol/d Catecholamines Norepinephrine Adults mg/24 h nmol/d h-urine with 1 g boric acid, HPLC Epinephrine 4 20 mg/24 h nmol/d Dopamine mg/24 h mmol/d Chloride Adults meq/l mmol/l h-urine meq/l mmol/l 1st morning urine meq/24 h mmol/d h-urine Citrate Adults <805 mg/24 h <4.2 mmol/d 107 (as citric acid) Copper Adults mg/24 h mmol/d 171 Cortisol, free Adults mg/24 h nmol/d h-urine, Cortisol Elecsys ¾ JANUAR_2010_ENGLISCH SEITE :45 3. Autorkorrektur

59 2.6.2 Clinical chemical urinalysis Analyte s References Notes Group Conventional SI C-Peptide Adults mg/24 h nmol/d h-urine, C-Peptide Elecsys ¾ Creatinine Adults f mg/dl mmol/l 172 Roche Diagnostics, kinetic Jaff method, m mg/dl mmol/l rate-blanked, compensated, 1st morning urine. f g/24 h mmol/d 126 Roche Diagnostics, kinetic Jaff method, m g/24 h mmol/d rate-blanked, compensated, 24 h-urine. f mg/dl mmol/l 172 Roche Diagnostics, enzymatic method, m mg/dl mmol/l 1st morning urine. f g/24 h mmol/d 126 Roche Diagnostics, enzymatic method, m g/24 h mmol/d 24 h-urine. Creatinine clearance Adults ml/min ml/min 126 Roche Diagnostics, Jaff kin., rateblanked, compensated, measured ml/min ml/min Calculated acc. to Cockroft-Gault ml/min ml/min Calculated using MDRD study formula ml/min ml/min Roche Diagnostics, Jaff kin., rateblanked, non-compensated, measured ml/min ml/min Calculated acc. to Cockroft-Gault ml/min ml/min Calculated using MDRD study formula ml/min ml/min Roche Diagnostics, enzym. method, measured ml/min ml/min Calculated acc. to Cockroft-Gault ml/min ml/min Calculated using MDRD study formula. Cystine Clinical patients mg/24 h pmol/d h-urine, ph 2 3 Deoxypyridinolin total mg/g crea 5 17 mmol/mol crea 23 free 6 35 mg/g crea mmol/mol crea Fructose Adults <60 mg/24 h <0.3 mmol/d 105 Galactose Neonates <60 mg/dl <3.3 mmol/l 105 Adults <14 mg/24 h <0.1 mmol/d Glomerular 30 yr ml/min ml/min Cr-EDTA clearance filtration rate 50 yr ml/min ml/min (GFR) 70 yr ml/min ml/min Glucose Adults <20 mg/dl <1.1 mmol/l 218 1st morning urine. <15 mg/dl <0.8 mmol/l Spontaneously voided urine. <17 mg/dl <0.96 mmol/l h-urine 5-Hydroxyindole Adults <8 mg/24 h <41 mmol/d h-urine, HPLC acetic acid Hydroxyproline Adults, yr mg/24 h q m 2 body surf mmol/d q m 2 body surf h-urine JANUAR_2010_ENGLISCH SEITE 57

60 2.6.2 Clinical chemical urinalysis Analyte s References Group Conventional SI Immunoglobulin light chains k/l ratio Immunoglobulin G (IgG) Adults Roche Diagnostics, immunoturbidimetric method Children <1mth 1 12 mth mg/l Not detectable mg/l Not detectable 112 Spontaneously voided urine, radial immunodiffusion 1 5 yr mg/l mg/l 6 10 yr mg/l mg/l 11 15yr mg/l mg/l Adults <9 mg/24 h (<9 mg/g crea) <9 mg/d (<1.0 g/mol crea) 88 Roche Diagnostics, immunoturbidimetric method Iron <98 mg/24 h <1.8 mmol/d h-urine Lysozyme <3.6 mg/24 h <3.6 mg/d 299 Magnesium mg/24 h 4 5 mmol/d h-urine mg/dL mmol/l h-urine Mercury Adults < 26 mg/l < 130 nmol/l 230 a 1 -Microglobulin Children <1 mth mg/l mg/l 112 Radial immunodiffusion, spontaneously 1 12 mth mg/l mg/l voided urine. 1 5 yr mg/l mg/l 6 10 yr mg/l mg/l yr mg/l mg/l Adults <20 mg/24 h (<1.2 mg/dl) <20 mg/d (<12 mg/l) h-urine <14 mg/g (<1.58 g/mol) crea <52.6 mmol/mol crea 2nd morning urine Osmolality mosmol/kg mmol/kg 133 Oxalate Children 1 12 mth f <23 mg/24 h <0.27 mmol/d h-urine collected with 10 ml conc. HCl m <57 mg/24 h <0.65 mmol/d 1 3 yr f <38 mg/24 h <0.43 mmol/d m <44 mg/24 h <0.50 mmol/d 4 6 yr f <35 mg/24 h <0.40 mmol/d m <41 mg/24 h <0.47 mmol/d 7 9 yr f <38 mg/24 h <0.44 mmol/d m <31 mg/24 h <0.35 mmol/d yr f <35 mg/24 h <0.40 mmol/d m <32 mg/24 h <0.37 mmol/d yr f <39 mg/24 h <0.44 mmol/d m <35 mg/24 h <0.40 mmol/d Adults <45 mg/24 h < 0.50 mmol/d 107 Phosphate, yr g/24 h mmol/d h-urine, on nonrestricted diet inorganic mg/dl mmol/l 148 1st morning urine Notes JANUAR_2010_ENGLISCH SEITE 58

61 2.6.2 Clinical chemical urinalysis Analyte s References Notes Group Conventional SI Porphyrins Total porphyrin Adults <100 mg/24 h <120 nmol/d 60 Protect sample from light Uroporphyrin <24 mg/24 h <29 nmol/d Heptacarboxyporphyrin <3 mg/24 h <4 nmol/d Hexacarboxyporphyrin <2 mg/24 h <3 nmol/d Pentacarboxyporphyrin <4 mg/24 h <6 nmol/d Coproporphyrin mg/24 h nmol/d Tricarboxyporphyrin <2 mg/24 h <2 nmol/d Dicarboxyporphyrin <1 mg/24 h <1 nmol/d Potassium Adults meq/l mmol/l h-urine meq/l mmol/l 1st morning urine meq/24 h mmol/24 h h-urine Protein, Total Adults <15 mg/dl <150 mg/l 128 Benzethonium chloride method, random urine <14 mg/dl <140 mg/l 299 Turbidimetry, nephelometry, 24 h-urine <150 mg/24 h <150 mg/d 218 Benzethonium chloride method, 24 h-urine Pyridinolin, total Adults mg/g crea mmol/mol crea h-urine or spontaneously voided urine. free mg/g crea mmol/mol crea Sampling between 11 a.m. and 1 p.m. Sodium Adults meq/l mmol/l h-urine meq/l mmol/l 1st morning urine meq/24 h mmol/24 h h-urine Transferrin Adults <1 mg/g crea <113 mg/mol crea 88 Spontaneously voided urine <1 mg/24 h <1 mg/d 24 h-urine Urea Adults <35 g/24 h <580 mmol/d h-urine g/dl mmol/l 1st morning urine g/24 h mmol/d h-urine Uric acid Adults g/24 h mmol/d h-urine, concn.considerablydiet-related mg/dl mmol/l 148 1st morning urine, concn. considerably diet-related Vanillylmandelic acid (VMA) Adults mg/24 h mmol/d JANUAR_2010_ENGLISCH SEITE 59

62 2.7 Urinary calculi, gallstones Concrement Major components References Gallstones Bilirubin 99 Calcium carbonate Cholesterol Urinary calculi Calcium hydrogen phosphate dihydrate 99 Calcium oxalate dihydrate Calcium oxalate monohydrate Carbonate apatite Cystine 2,8-Dihydroxyadenine Magnesium ammonium phosphate hexahydrate Magnesium ammonium phosphate monohydrate Mono-ammonium urate Mono-sodium urate monohydrate Protein Uric acid Uric acid dihydrate Xanthine JANUAR_2010_ENGLISCH SEITE 60

63 2.8 CSF Analyte References Group Conventional SI Albumin Adults mg/l mg/l 211 Albumin, CSF/ serum ratio Cells Glucose Children 15 yr 5.0 q q , 218 Adults 40 yr 6.5 q q yr 8.0 q q 10 3 Neonates Adults Children Adults <32 leucocytes/ml <3 leucocytes/ml mg/dl mg/dl <32 mpt leucocytes/l <3 mpt leucocytes/l mmol/l mmol/l IgA Adults mg/l nmol/l 211 IgG Adults mg/l nmol/l 211 IgM Adults mg/l nmol/l 211 Lactate Neonates mg/dl mmol/l 299 Children 3 10 d mg/dl mmol/l >10 d mg/dl mmol/l Notes Protein, total Adults mg/dl mmol/l 98 Premature infants w of pregnancy mg/dl g/l w of pregnancy mg/dl g/l w of pregnancy mg/dl g/l 1 d 1 mth mg/dl g/l 2 3 mth mg/dl g/l 4 6 mth mg/dl g/l 7 12 mth mg/dl g/l 2 yr mg/dl g/l 3 4 yr mg/dl g/l 5 8 yr mg/dl g/l Adults <45 mg/dl <0.45 g/l Electrophoresis Prealbumin % Albumin % a 1 -Globulin % a 2 -Globulin % b-globulin % g-globulin % JANUAR_2010_ENGLISCH SEITE 61

64 2.9 Stool Analyte s References Notes Conventional SI Albumin <100 mg/fecal smear <100 mg/fecal smear 185 Blood Not detectable Not detectable 214 No intake of fish, meat, radish, horseradish, iron- or copper-containing preparations 3 days prior to test Chymotrypsin Adults >13.2 U/g >220 nkat/g 218 Composition Dry substance g/24 h g/d 214 Volume of water ml/24 h ml/d Neutral fats <7 g/24 h <7 g/d Bile acid mg/24 h mg/d Stercobilinogen + Stercobilin mg/24 h mg/d Copper <46 mg/g stool <0.72 mmol/g stool 52 Lactoferrin <2.4 mg/g stool <2.4 mg/g stool 276 Pancreatic Neonates mg/g stool mg/g stool 258 elastase Infants, children mg/g stool mg/g stool Adults >200 mg/g stool >200 mg/g stool 231 Normal mg/g stool mg/g stool Light to medium insufficiency < 100 mg/g stool <100 mg/g stool Strong insufficiency Weight Adults g/24 h g/d 214 Zinc Adults <408 mg/g stool <408 mg/g stool JANUAR_2010_ENGLISCH SEITE 62

65 2.10 Spermiogram Analyte s References a-glucosidase > 20 mu/ejaculate 291 Acid phosphatase > 200 mmol/ejaculate Citrate > 52 mmol/ejaculate Fructose > 13 mmol/ejaculate Leucocytes < 1 mil/ml MAR test < 10 % of spermatozoa with adhesive particles or erythrocytes Morphology > 30 % normally formed spermatozoa Motility > 50 % spermatozoa with progressive motility (categories a and b) or > 25 % spermatozoa with rapid progressive motility (category a) ph Sperm concentration > 20 mil spermatozoa/ml Total sperm count > 40 mil spermatozoa/ejaculate Vitality > 75 % vital spermatozoa, i.e. cells not absorbing eosin dye Volume > 2 ml Zinc > 2.4 mmol/ejaculate Analyte s References Normozoosperms Normal ejaculate findings 291 Oligozoosperms < 20 mil spermatozoa/ml Cryptozoosperms < 1 mil spermatozoa/ml Polyzoosperms > 250 mil spermatozoa/ml Asthenozoosperms < 50 % of spermatozoa with progressive motility (categories a and b) and < 25 % of spermatozoa with motility of category a Teratozoosperms < 30 % of spermatozoa with normal morphology Oligoasthenoteratozoosperms Azoosperms Parvisemia Hypersemia Aspermia Hemosperms Combination of oligo-, astheno- and teratozoosperms No spermatozoa in the ejaculate Ejaculate volume < 2 ml Ejaculate volume > 6 ml No ejaculate Erythrocytes in ejaculate JANUAR_2010_ENGLISCH SEITE 63

66 2.11 Extravascular body fluids Amniotic fluid Analyte s Ref. 9 Albumin < 3.0 g/l >= Bicarbonate mmol/l 39 Bilirubin < 0.1 mg/dl >; Calcium mmol/l CEA < 107 mg/l 61 Chloride mmol/l 39 Creatinine mg/dl 39 Erythropoietin U/L 37 Glucose mg/dl 39 hcg < 4300 IU/L 61 Lysozyme 6 12 mg/l 91 Osmolality mosmol/kg 39 Phosphate, inorg mmol/l 39 Potassium mmol/l 39 Prolactin < 70 nmol/l 9 61 Protein < 4.0 g/l = Sodium mmol/l 39 ; Urea mg/dl Ascites Analyte s Ref. Nonmalignant Malignant 9 CEA < 2.5 mg/l > 2.5 mg/l = Cholesterol < 45 mg/dl > 45 mg/dl 76 ; LDH < 60 % of the > 60 % of the serum LDH serum LDH Phospholipids mmol/l mmol/l 75 Protein < 30 g/l > 30 g/l 76 Triglycerides mg/dl mg/dl 75 Bile, clear colorless fluid Analyte s Ref. 9 Bilirubin < 1.3 mg/dl Calcium mmol/l >= Chloride mmol/l 274 Cholesterol 6 20 mg/dl >; Glucose < 5 mg/dl Lysozyme < 0.8 mg/l 9 91 Magnesium < 0.2 mmol/l Osmolality mosmol/kg ph >= Phosphate, inorg. < 1.0 mmol/l 274 Phospholipids < 50 mg/dl Potassium mmol/l Protein < 9 g/l >; Sodium mmol/l Bile, yellow bile Analyte s Ref. 9 Bicarbonate 7 42 mmol/l Bilirubin 9 77 mg/dl >= Calcium mmol/l 274 Chloride mmol/l >; Cholesterol mg/dl Color yellow Glucose < 8 mg/dl 274 Iron excretion mmol/h Magnesium mmol/l Osmolality mosmol/kg ph >= Phosphate, inorg. < 0.6 mmol/l 274 Phospholipids mg/dl Protein 2 6 g/l Potassium mmol/l >; Sodium mmol/l Volume L/24 h JANUAR_2010_ENGLISCH SEITE 64

67 Coelomic fluid Analyte s Ref. 9 Albumin g/l Bicarbonate mmol/l Bilirubin < 0.5 mg/dl Calcium mmol/l Chloride mmol/l >= Creatinine mg/dl 39 Glucose mg/dl Osmolality mosmol/kg Phosphate, inorg mmol/l Potassium mmol/l Sodium mmol/l >; Urea mg/dl Duodenal fluid Analyte s Ref. 9 Calcium mmol/l = Potassium mmol/l 77 ; Sodium mmol/l 8 9 Amylase U/min Bicarbonate 8 73 mmol/h >< >= Chymotrypsin after secretin stimulation U/min 225 Lipase U/min Trypsin 1 42 mg/min >: >; Volume ml/h Gastric juice Analyte s Ref. Ammonium mmol/l 136 Ascorbic acid mg/l 207 Calcium mmol/l 178 CEA < 0.5 mg/l 32 Chloride 6 48 mth mmol/l 3 Adults mmol/l 178 Citrate mg/dl 201 Free acid < 78 mmol/l 178 b-glucosidase < 5.0 mg/l 221 Lactate mg/dl 201 LDH < 35 U/L 221 Lysozyme mg/l 91 Magnesium mmol/l 178 Mucin < 0.4 g/l 17 ph 6 48 mth Adults Potassium 6 48 mth mmol/l 3 Adults mmol/l 178 Pyruvate mg/dl 190 Sodium 6 48 mth mmol/l 3 Adults mmol/l 178 Urea mg/dl 201 Uric acid mg/dl 201 Lymph Analyte s Ref. 9 Albumin g/l Amylase U/L Calcium mmol/l Chloride mmol/l Cholesterol mg/dl Erythrocytes /mL Glucose mg/dl >= GOT U/L 277 GPT 5 21 U/L Leucocytes /mL ph Potassium mmol/l Protein g/l Sodium mmol/l Triglycerides higher than in serum >; Urea mg/dl Differentiation between chyle and pseudochyle is possible with the detection of chylomicrons (only in chyle) and triglycerides 2 to 8 times higher in chyle than in pseudochyle (45) JANUAR_2010_ENGLISCH SEITE 65

68 Milk, human Analyte s Ref. Calcium mmol/l 70 Chloride mmol/l 282 Cholesterol mg/dl 29 Copper mg/l 119 Folate 8 13 mg/dl 222 g-gt U/L 197 Iron mg/l 119 Lactose g/l 282 Lysozyme mg/l 91 Magnesium mmol/l 70 Phosphate, inorg mmol/l 70 Phospholipids mg/dl 29 Potassium mmol/l 70 Protein g/l 135 Sodium mmol/l 29 Triglycerides g/dl 9 19 Vitamin A mg/dl Vitamin B mg/dl Vitamin B mg/dl >= Vitamin B mg/dL 222 Vitamin B mg/dl Vitamin C mg/dl Vitamin E mg/dl >; Vitamin K mg/dl Zinc mg/l 119 Nasal secretion Analyte s Ref. Calcium mmol/l 63 Glucose < 10 mg/dl b 2 -Microglobulin not detectable >= Potassium 6 28 mmol/l 63 Protein 1 35 g/l >; Sodium mmol/l Pancreatic juice Analyte s Ref. Amylase U/min Bicarbonate > 70 mmol/l Chymotrypsin U/min 213 Lipase after stimulation U/min Potassium 3 10 mmol/l 167 Protein g/l 296 Trypsin U/min 213 Volume > 1.6 ml/min 213 fflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl{zfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl} Peritoneal fluid Analyte s Ref. Amylase U/L 92 Creatinine mg/dl 170 D-dimer < 0.77 mg/l 287 Urea 3 27 mg/dl 170 Volume 1 9 ml 287 Pleural fluid Analyte s Ref. Transsudate Exsudate 9 LDH < 200 U/L > 200 U/L LDH punctate/ >= serum ratio < 0.6 > Protein < 3 g/dl > 3 g/dl >; Protein punctate/ serum ratio < 0.5 > Cells /mL Mesothelial cells 3 70 % >= Monocytes % 30 Lymphocytes 2 30 % Granulocytes < 10 % >; Glucose equal to plasma pco mmhg 279 ph Protein g/dl Albumin % of protein 30 Volume ml/kg body weight fflfflfflfflfflffl{zfflfflfflfflfflffl} fflfflffl{zfflfflffl} JANUAR_2010_ENGLISCH SEITE 66

69 Saliva Analyte s Ref. Parotid saliva Submandibular saliva Calcium mmol/l 177 Flowrate ml/15 min ml/15 min 14 IgA IU/mL < 4.5 IU/mL 14 ph Potassium mmol/l 177 Protein g/l g/l 14 Sodium mmol/l 177 Mixed saliva Albumin mg/l 87 ALP < 11 U/L 209 Ammonium mmol/l 117 Amylase U/L 209 Calcium mmol/l Cells x 10 6 /g Macrophages % Neutrophiles % >= Bronchial epithelial <4% 26 cells Lymphocytes < 3 % >; Eosinophiles < 1 % Chloride 5 40 mmol/l 86 CO 2 < 11 mmol/l 209 Cortisol morning 3 43 nmol/l 218 evening < 10 nmol/l 218 Creatinine mg/dl Glucose < 2 mg/dl = GOT < 43 U/L 209 GPT < 11 U/L ; IgA mg/l 87 LDH U/L 209 Lysozyme 6 12 mg/l 9 91 Magnesium mmol/l Osmolality mosmol/kg >= ph Phospate, inorg mmol/l >; Potassium mmol/l Protein g/l 87 Sodium 2 21 mmol/l 86 Testosteron mg/l 243 Urea mg/dl 209 Uric acid mg/dl 209 Sweat Analyte s Ref. Ammonium mmol/l 9 35 Chloride 6 15 yr f mmol/l m mmol/l yr f mmol/l m mmol/l >= yr f mmol/l 6 m mmol/l yr f mmol/l m mmol/l yr f mmol/l >; m mmol/l Glucose < 7 mg/dl 168 Lactate mmol/l Lysozyme mg/l = a 1 -Microglobulin 6 34 mg/l 100 ; b 2 -Microglobulin mg/l ph Potassium 6 15 yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l >= m mmol/l 6 Sodium 6 15 yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l m mmol/l yr f mmol/l >; m mmol/l Urea mg/dl 257 Uric acid mg/dl 257 Volume 500 ml/24 h JANUAR_2010_ENGLISCH SEITE 67

70 Synovial fluid Analyte s Ref. C 3C mg/dl 9 27 Cell count < 800/mL = Colour light yellow and clear 229 ; Glucose equal to plasma Hyaluronic acid g/l 9 41 IgA mg/dl = IgG mg/dl 27 ; IgM mg/dl Immunoglobulins about 50 % serum conc. 232 Interleukin-1b < 1.5 pg/ml 5 Lactate equal to plasma 232 LDH < 240 U/L 232 ph Protein < 25 g/l = Salts no 232 ; Segmented granulocytes < 10 % Serotonin < 0.5 nmol/l 5 Uric acid equal to serum 232 Volume nearly 3.5 ml 232 Tears Analyte s Ref. Albumin mg/l 175 Chloride 128 mmol/l 86 Cholesterol mg/dl 111 Glucose mg/dl 120 HbA 1c % IgA mg/l IgG 3 7 mg/l >= IgM 5 13 mg/l Lactoferrin 3 7 mg/l Lysozyme g/l >; b 2 -Microglobulin g/l 175 ph Potassium 16 mmol/l 86 Protein g/l 174 Sodium 146 mmol/l 86 Volume 1 2 ml/24 h Function tests 1. Oral glucose tolerance test (96) The patient eats a mixed diet consisting of more than 150 g carbohydrates per day over a period of 3 days. Any drugs known to affect glucose metabolism should be discontinued 3 days before the test. The patient must fast for a period of 12 hours. A urine sample taken from the fasting patient should be tested for glucose and ketone bodies (a positive test-strip result is a contraindication for an OGTT). The patient drinks a solution of 75 g oligosaccharides; children: 1.75 g glucose per kg body weight up to a maximum of 75 g. Exception: Pregnant women receive 50 g glucose to screen for gestational diabetes. The patient should remain seated during the test. A blood sample is collected from the fasting patient, then after 120 minutes. Glucose concentration Plasma Capillary blood fasting 120 min. fasting 120 min. Normal range mg/dl < 110 < 140 < 95 < 140 mmol/l < 6.1 < 7.8 < 5.3 < 7.8 Borderline range mg/dl mmol/l Pathological range mg/dl > 126 > 200 > 110 > 200 (Diabetes mellitus) mmol/l > 7.0 > 11.1 > 6.1 > JANUAR_2010_ENGLISCH SEITE 68

71 2. Hydrogen (H 2 ) breath test (157) The patient must fast for a period of 12 hours and not eat any heavy foods 24 hours prior to the test. The patient should not smoke or drink any mineral water 12 hours prior to the test. The patient drinks a solution of 50 g lactose and 300 ml water in 5 minutes. Children are administered 2 g lactose per kg body weight up to a maximum of 50 g lactose. The H 2 concentration is measured in the breath expired prior to the start of the test, then at 30, 60 and 90 minute intervals following administration of the lactose. Reference range: A rise of < 20 ppm in the H 2 concentration of the alveolar air between the lowest and the highest value finally expired (refer also to curve constructed). 3. Creatinine clearance (126) Void the bladder of prior to the test and discard the urine. Collect urine over a period exactly 24 hours. Do not add stabilizing agents; store urine in the refrigerator or at room temperature. A blood sample should be collected at the beginning and end of the collection period. The volume of the urine collected should be measured exactly, mixed thoroughly and approximately 10 ml sent to the laboratory. I. Calculation formula for a body surface area of 1.73 m 2 C cr = UqV (ml/min) S II. Calculation formula for other body surface areas C cr = UqVq1.73 (ml/min/1.73 m 2 ) SqBSA Note: For accurate evaluation of the endogenous creatinine clearance rate, it is necessary to perform two serum creatinine determinations at 24-hour intervals. The values obtained should not differ from each other by more than 10 %. Since the determination of the C Cr based on a timed urine collection is inconvenient and often unreliable, various mathematical approaches for the estimation of C Cr from the serum creatinine concentration were suggested. Two of these approaches have found wide recognition: JANUAR_2010_ENGLISCH SEITE 69

72 I. Calculation according to Cockroft-Gault Males: 140 ageqweight C cr = (ml/min) 75qS Females: 140 ageqweightq0.85 C cr = (ml/min) 75qS II. Calculation according to the modified MDRD (Modification of Diet in Renal Disease) study formula Males: C cr = 175qS qage (ml/min) Females: C cr = 175qS qage :742 (ml/min) Nomogram for the determination of body surface area (BSA) in square meters (63) C cr = Clearance in ml/min U = Urine creatinine concentration in mg/dl V = Volume of collected urine in ml, related to 1 min S = Serum creatinine concentration in mg/dl BSA = Body surface area in m 2 Connect the height in cm and the weight in kg with the edge of a transparent ruler and read the surface area in square meters at the point of intersection with the middle scale JANUAR_2010_ENGLISCH SEITE 70

73 4. Lactose tolerance test (189) The patient must fast for a period of 12 hours. The patient drinks a solution of 50 g lactose in 400 ml water. Infants are given 4 g lactose per kg body weight. Children older than 2 years are given 2 g lactose per kg body weight up to a maximum of 50 g lactose. Capillary blood is collected for glucose determination prior to the start of the test, then at 30, 60, 90 and 120 minute intervals following administration of the lactose. Reference range: A rise in the blood glucose concentration of > 20 mg/ dl (> 1.1 mmol/l) indicates the absence of gastrointestinal disorders. Notes on test for exclusion of glucose-galactose malabsorption: Infants: + 2 g glucose + 2 g galactose/kg + body weight Children older than 2 years:+ 1gglucose + 1 g galactose/kg + body weight 5. D-xylose absorption test The patient must fast for a period of 12 hours. The bladder should be voided immediately prior to the test. The patient drinks a solution of 25 g D- xylose in 500 ml tea. The patient drinks a further 250 ml tea after a period of one to two hours. The patient must remain seated during the test. Urine is collected over a period of 5 hours. Children are administered 5 g D-xylose in 100 ml water or tea. Reference ranges: Urine (199): A D-xylose excretion in 5-hour urine of > 4.5 g (30 mmol), i. e. of > 18 % (0.18) of the amount of D-xylose administered. For children with 4 30 kg body weight (225): A serum D-xylose concentration of > 20 mg/dl (> 1.33 mmol/l) after a period of 1 hour. Adults: + 25 g glucose +25ggalactose JANUAR_2010_ENGLISCH SEITE 71

74 2.13 Characteristic analytes for identification of body fluids Amniotic fluid Ascites Bile Cerebrospinal fluid Cyst fluid Duodenal contents Gastric secretion Nasal secretion Pancreatic secretion Pericardial fluid Peritoneal fluid Pleural fluid a 1 -fetoprotein (AFP) > 10 mg/l No characteristic analytes Bile acids (chenodesoxycholic acid) b 2 -Transferrin (not absolutely specific), chloride mmol/l, calcium mmol/l, glucose approx % of the plasma concentration, protein < 50 mg/dl (serum times higher) Breast cysts: FSH and LH lower than in serum Renal cysts: same composition as urine Ovarian cysts (follicular cysts): estradiol elevated Pancreatic cysts: amylase, lipase High activities of amylase, lipase, trypsin, chymotrypsin ph , ammonia > 0.6 mmol/l Glucose < 10 mg/dl, protein 1 35 g/l, potassium 6 28 mmol/l, no b 2 -transferrin High activities of amylase, lipase, trypsin, chymotrypsin No characteristic analytes Ammonia > 300 mg/dl No characteristic analytes Saliva Sodium 2 21 mmol/l, potassium 6 37 mmol/l, chloride 5 40 mmol/l, albumin mg/l, salivary amylase Semen Sperm Sweat Glucose < 7 mg/dl, potassium > 11 mmol/l Tear fluid Total protein g/l (10 % of the serum concentration) with large prealbumin fraction Urine Creatinine mg/dl, urea g/dl, inorganic phosphate mg/dl 3 Decision supports 3.1 Enzyme patterns x 30 x 25 x 20 x 15 x 10 x 5 x Hours Infarction Reference range 1 CK, total 2 CK-MB LDH 1 4 Myoglobin 5 Troponin T Typical enhancement of enzyme activities and protein concentrations after acute myocardial infarction (188). The y-axis represents multiples of the upper reference ranges limits JANUAR_2010_ENGLISCH SEITE 72

75 3.2 Lipids 3.3 Electrophoretic patterns of plasma proteins 1. The composition of lipoproteins Chylomicrons VLDL LDL HDL Protein electrophoresis of healthy persons Total cholesterol 6 % 8 13 % 45 % 20 % Phospholipids 4 % 6 15 % 25 % 30 % Triglycerides 87 % % 10 % 2 5 % Carbohydrates < 1 % 1 2 % > 2 % < 1 % Proteins 1 % 8 10 % 20 % 48 % Apoproteins A, B 48,C,E A,B 100,C,D,E B 100 A, C, E Protein-lipid-ratio 1:100 1:9 1:4 1:1 2. Classification of hyperlipoproteinemias according to FREDRICKSON Classes Cholesterol Triglycerides Appearance of fasting serum Prealbumin α 1 α 2 β γ Albumin α 1-Lipoprotein (HDL) α 1-Glycoprotein α 1-Antitrypsin α 2-Macroglobulin Haptoglobin Pre-β-Lipoprotein Transferrin β-lipoprotein Complement IgA IgM IgG Typ I < 260 mg/dl > 1000 mg/dl forms an upper creamy layer, clear lower phase Typ IIa > 300 mg/dl < 150 mg/dl clear Typ IIb > 300 mg/dl mg/dl clear or turbid Typ III mg/dl mg/dl turbid Typ IV < 260 mg/dl mg/dl turbid to milky Typ V > 300 mg/dl > 1000 mg/dl turbid lower phase Acute inflammation 3. Appearance of fasting sera at different classes of hyperlipoproteinemia according to FREDRICKSON normal Typ I Typ IIa Typ IIb Typ III Typ IV Typ V Prealbumin α 1 α 2 β γ Albumin Nephrotic syndrome Prealbumin α 1 α 2 β γ Albumin JANUAR_2010_ENGLISCH SEITE 73

76 3.4 Schematic representation of blood coagulation Chronic inflammation Endogeneous Aktivierung activation Exogeneous Aktivierung activation Oberflächenkontakt contact surface XII XIIa Gewebeverletzung tissue damage Prealbumin α 1 α 2 β γ Albumin Paraproteinemia XI XIa Gewebefaktor III tissue factor Ca 2+ +PL+IX VII IXa+VIII+PL+Ca 2+ Ca 2+ +PL+VIIa Ca 2+ +PL+X Xa+V+PL+Ca 2+ Prealbumin α 1 α 2 β γ Albumin Antibody deficiency syndrome Prothrombin Fibrinogen Thrombin Fibrin s XIIIa+Ca 2+ XIII Fibrin i Fibrinopeptides A+B Prealbumin α 1 α 2 β γ Albumin Schematic Schematische representation Darstellung of der plasmatic plasmatischen blood coagulation. Blutgerinnung. PL = phospholipids, Phospholipide, s s = soluble, i (löslich), = insoluble i = insoluble (unlöslich) JANUAR_2010_ENGLISCH SEITE 74

77 3.5 Thrombophilia, risk factors l Elevated triglyceride concentrations l Elevated LDL concentrations l Advanced age l Sex l Pregnancy or puerperium l Immobilization l Heavy cigarette smoking l Medicines oral contraceptives antifibrinolytica steroids (estrogenes) Sample collection Diagnostics Prior to all therapy regimes involving heparine or cumarine, withdraw a sample of blood for thrombophilia diagnostic analyses approximately 3 months after the thromboembolitic event and not during an acute phase reaction. Coagulation inhibitor deficiency or dysfunction: Antithrombin III (AT III) Protein C Protein S APC resistance Heparin cofactor II (rare) Factor XII deficiency (primary finding: prolonged aptt) l Illnesses with elevated thrombosis risk arteriosclerosis diabetes mellitus malignant disease l Family medical history l Relapse thrombosis (recurring thrombosis) l Unexplained prolongation of aptt l Women who have had repeated miscarriages l Patients suffering from autoimmune diseases Lupus anticoagulants (primary finding: prolonged aptt) Reduced fibrinolytic potential (rare): Plasminogen deficiency Decreased plasminogen activator (t-pa) concentrations Elevated plasminogen activator Inhibitor I (PAI-I) concentrations Congenital dysfibrinogenemia (rare) l Operations l Traumas l Hyperviscosity syndrome Polycythemia vera Macroglobulinemia l Infections and sepsis l Nephrotic syndrome JANUAR_2010_ENGLISCH SEITE 75

78 3.6 Age dependence of immunoglobulin synthesis 3.7 Complement system, classical and alternative mechanism Weeks Months years Cells IgM+ IgG+ Fetal time Child age Immunoglobulins (% of normal values of adults) Immunoglobulins (mg/dl) maternal IgG IgM IgG IgA Values of adults IgG IgA IgM Birth Alternative pathway Immune complexes (IgA), bacteria, fungi Classical pathway Immune complexes +C1 (IgA od. IgM) Functions C3 C3b + B C3bB D + H C3a H Ba C1- Complex C1qrs C4+C2 Opsonization by coating, immune adherance C3b,Bb C4b2a P C5- Convertase C3 C3b C5 C3a C5a Anaphylatoxic action C5b C6+C7 C8 Chemotaxis C9 C5b67 C5b678 Membrane attack complexes Cellular lysis JANUAR_2010_ENGLISCH SEITE 76

79 3.8 Tumor markers 3.9 Serological diagnosis of hepatitis A and B Tumormarkers marker of 1st choice marker of 2nd choice in brackets Oesophagus (CEA, SCC) Lung parvicellular: NSE (CYFRA 21-1) non-parvicellular: (CEA, CYFRA 21-1) Liver/Biliary ducts AFP, CA 19-9 Bladder (CYFRA 21-1) Uterus SCC (CEA) Prostate gland PSA Testes AFP, hcg Thyroid gland Thyroglobulin, Calcitonin (C-cell, CEA) Mamma CA 15-3, CEA Stomach CA 72-4 (CEA) Pancreas CA 19-9 (CEA) Colorectal CEA (CA 19-9) Ovaries CA 125 (CA 72-4) Multiple Myeloma β2 -Microglobulin Rel. concentration HAV Progress of a hepatitis A infection Acute phase Reconvalescence Immunity Days Days Years Duration Rel. concentration Incub Start of icterus Acute phase 2-12 Weeks HBsAg HBeAg Infectious Progress of a hepatitis B infection Symptoms Anti-HAV IgM Time after exposition Postacute phase 2-16 Weeks Infectious Anti-HBc Anti-HAV (IgG+IgM) Postinfection phase 5 Months up to years Anti-HBs Anti-HBe Anti-HBc IgM Immune JANUAR_2010_ENGLISCH SEITE 77

80 3.10 Urinary sediment Diagnostically relevant findings in urinary sediment: upper left: erythrocytes upper right: leucocytes middle left: epithelial cells middle right: calcium oxalate lower left: ammoniummagnesium phosphate (tripelphosphate) Diagnostically relevant findings in urine sediment: upper left: uric acid upper right: cystine middle left: tyrosine middle right: granulated casts lower left: erythrocyte casts JANUAR_2010_ENGLISCH SEITE 78

81 3.11 Nomogram for diagnosing acid-base disorders (185) 4 Conversion tables 4.1 Conversion table from conventional units to SI units and vice versa (/U refers to urinalysis) Analyte/Parameter Conventional Units Conversion Factors SI Units Acetaminophen 6.62 mmol/l mg/ml N-Acetylprocainamide (NAPA) mg/ml mmol/l a 1 -Acid glycoprotein 0.25 mmol/l mg/dl 4.0 ACTH pmol/l ng/l Albumin 10 g/l g/dl 0.1 Albumin/U g/mol crea mg/g crea 8.85 Aldosterone pmol/l ng/dl Amikacin 1.71 mmol/l mg/ml Nomogram for diagnosing acid-base disorders considering the degree of compensation. pco 2 is represented logarithmically on the abscissa. Bicarbonate concentration is reported on the ordinate. The patient s values result in an ordered pair, the status point, which allows the classification of a singular acid-base disorder as acute or chronic or which suggests a combined disorder. If the disorder appears with a normal degree of compensation, the status point is found within one of the corresponding, shaded fields. If the status point doesn t fall within one of these fields, it must be decided which of the following situations is present: the disorder just appeared, compensation has not yet taken place. the organ which is responsible for compensation, such as the lung for respiratory and the kidney for metabolic disorders, is not functioning properly. a second acid-base disorder is present, e.g. respiratory acidosis in ventilatory failure and lactic acidosis might be present simultaneously. d-aminolevulic acid/u mg/24 h mmol/d Ammonium (NH 3 ) mmol/l mg/dl AMP, 3l-5l-cyclic 3.04 nmol/l ng/ml a 1 -Antitrypsin mmol/l ng/ml JANUAR_2010_ENGLISCH SEITE 79

82 Analyte/Parameter Conventional Units Conversion Factors SI Units Apolipoprotein A mmol/l mg/dl 2.80 Apolipoprotein B 1.95 mmol/l g/l Ascorbic acid mmol/l mg/dl Bilirubin 17.1 mmol/l mg/dl Caffeine 5.15 mmol/l mg/ml Calcitonin 0.28 pmol/l ng/l 3.57 Calcium mmol/l mg/dl 4.01 Calcium/U mmol/d mg/24 h 40.1 Calcium/U mol/mol crea mg/g crea 355 Carbamazepine 4.23 mmol/l mg/l Analyte/Parameter Conventional Units Conversion Factors SI Units Ceruloplasmin mmol/l mg/dl Chloramphenicol 3.09 mmol/l mg/ml Chloride/U 3.18 mol/mol crea g/g crea Cholesterol mmol/l mg/dl Citrate 52.1 mmol/l mg/dl Citrate/U mmol/d mg/24 h 192 Copper mmol/l mg/dl Copper/U mmol/d mg/24 h Coproporphyrins nmol/l mg/l Cortisol nmol/l mg/dl Carcinoembryonic antigen (CEA) ng/ml miu/ml Cortisol/U nmol/d mg/24 h Carnitin mmol/l mg/dl Carotene mmol/l mg/dl C-Peptid nmol/l ng/ml 3.0 Creatinine 88.4 mmol/l mg/dl JANUAR_2010_ENGLISCH SEITE 80

83 Analyte/Parameter Conventional Units Conversion Factors SI Units Creatinine/U 8.84 mmol/d g/24 h Analyte/Parameter Conventional Units Conversion Factors SI Units Ethosuximide 7.08 mmol/l mg/l C-reactive protein (CRP) mg/dl nmol/l a 1 -Fetoprotein (AFP) 0.83 IU/mL ng/ml 1.21 Cystine/U 8.34 mmol/d mg/24 h 0.12 Fluoride mmol/l mg/l 19.0 Dehydroepiandrosterone sulfate (DHEA-S) mg/dl mmol/l Folic acid nmol/l ng/ml Digitoxin 1.31 nmol/l ng/ml 0.76 Digoxin 1.28 nmol/l ng/ml Disopyramide 2.95 mmol/l mg/l Fructose mmol/l mg/dl Fructose/U mmol/d mg/24 h FT pmol/l pg/ml Dopamine Dopamine/U ng/l pmol/l FT pmol/l ng/dl Epinephrine 5.46 pmol/l ng/l Epinephrine/U 5.46 nmol/d mg/24 h Estradiol (E2) 3.67 pmol/l pg/ml Estriol (E3) 3.47 nmol/l ng/ml Ethanol mmol/l mg/dl Galactose mmol/l mg/dl Galactose/U mmol/d mg/24 h Gentamicin 2.09 mmol/l mg/ml Glucose mmol/l mg/dl Glycerol mmol/l mg/dl JANUAR_2010_ENGLISCH SEITE 81

84 Analyte/Parameter Conventional Units Conversion Factors SI Units Haptoglobin 0.1 mmol/l mg/dl 100 Hemoglobin mmol/l g/dl 1.61 Homocysteic acid 7.41 mmol/l mg/l b-hydroxybutyrate 96.2 mmol/l mg/dl Analyte/Parameter Conventional Units Conversion Factors SI Units IgM 1.03 mmol/l g/l Insulin pmol/l mu/ml Iron mmol/l mg/dl 5.59 Iron/U mmol/d mg/24 h Hydroxycorticosteroids mg/dl mmol/d Lactate mmol/l mg/dl Hydroxyindole acetic acid/u mg/24 h mmol/d Lead mmol/l mg/l Hydroxyprogesterone ng/ml nmol/l Lecithin 12.5 mmol/l mg/dl Hydroxy-vitamin D mmol/l ng/ml 0.40 Hydroxyproline mmol/l mg/l IBC mmol/l mg/dl 5.59 IgA 6.25 mmol/l g/l 0.16 IgE 0.42 IU/mL mg/ml 2.4 IgG 6.67 mmol/l g/l Leucine 76.3 mmol/l mg/dl Lidocaine 4.27 mmol/l mg/l Lithium mmol/l mg/dl Magnesium mmol/l mg/dl Magnesium/U mmol/d mg/24 h Magnesium/U mol/mol crea mg/g crea JANUAR_2010_ENGLISCH SEITE 82

85 Analyte/Parameter Conventional Units Conversion Factors SI Units Mercury mmol/l mg/l Analyte/Parameter Conventional Units Conversion Factors SI Units Phenobarbital 4.31 mmol/l mg/l Methemoglobin (Hb/4; Mr = ) g/dl mmol/l Phenylalanine mmol/l mg/dl 16.5 a 1 -Mikroglobulin (Orosomucoid) mg/l nmol/l Phenytoin 3.96 mmol/l mg/l a 1 -Microglobulin/U g/mol crea mg/g crea b 2 -Microglobulin 84.7 nmol/l mg/l Myoglobin nmol/l ng/ml Norepinephrine 5.91 pmol/l ng/l Norepinephrine/U 5.91 nmol/d mg/24 h Phosphate, inorganic mmol/l mg/dl Phosphate/U 32.3 mmol/d g/24 h Phosphate/U mol/mol crea mg/g crea 277 Phospholipids mmol/l mg/dl po kpa mm Hg N-terminal-pro brain natriuretic peptide (NT-proBNP) pg/ml pmol/l Porphobilinogen 4.42 mmol/l mg/l Oxalate/U 11.4 mmol/d mg/24 h Oxyhemoglobin 0.01 l % 100 Porphyrine/U 1.2 nmol/d mg/24 h Potassium mmol/l mg/dl 3.91 Parathyrin (parathyroid hormone, PTH) ng/l pmol/l Prealbumin mmol/l mg/dl pco kpa mm Hg Primidone 4.58 mmol/l mg/l JANUAR_2010_ENGLISCH SEITE 83

86 Analyte/Parameter Conventional Units Conversion Factors SI Units Procainamide 4.23 mmol/l mg/l Progesterone 3.18 nmol/l ng/ml Prolactin 21.2 mu/l ng/ml Protein 10.0 g/l g/dl 0.1 Protein/U g/mol crea mg/g crea 8.85 Pyruvate mmol/l mg/dl Quinidine 3.08 mmol/l mg/l Salicylate mmol/l mg/l 138 Selenium mmol/l mg/l Analyte/Parameter Conventional Units Conversion Factors SI Units Sorbitol 54.9 mmol/l mg/dl T nmol/l ng/ml T nmol/l mg/dl Testosterone 3.47 nmol/l ng/ml Thallium 5.92 nmol/l mg/l Theophylline 5.55 mmol/l mg/l Tobramycin 2.14 mmol/l mg/l Transferrin mmol/l mg/dl Triglycerides mmol/l mg/dl 87.5 Sexual hormone binding globulin (SHBG) mg/ml nmol/l Urea mmol/l mg/dl Sodium mmol/l mg/dl 2.30 Sodium/U 4.90 mol/mol crea g/g crea Urea/U 16.7 mmol/d g/24 h 0.06 Urea/U mol/mol crea g/g crea Soluble transferrin receptor (stfr) mg/l nmol/l Uric acid 59.5 mmol/l mg/dl JANUAR_2010_ENGLISCH SEITE 84

87 Analyte/Parameter Conventional Units Conversion Factors SI Units Uric acid/u 5.95 mmol/d g/24 h Uric acid/u mol/mol crea mg/g crea 1487 Urobilinogen 16.9 mmol/l mg/dl Valproic acid 6.93 mmol/l mg/l Conversion factors for enzyme activities: U/L «mkat/ L and nkat/ L Unit Factor Unit mkat/l 60 U/L nkat/l 0.06 U/L U/L mkat/l U/L nkat/l 1 mkat/l W mmol/s L 1 nkat/l W 1nmol/s L 1 mmol/min W nkat 1 mmol/min W 1U Vancomycin mmol/l mg/ml Vanillylmandelic acid/u mg/24 h mmol/d Vitamin A (retinol) mmol/l mg/dl Vitamin B 1 (thiamin) 37.7 nmol/l mg/dl Vitamin B 6 (pyridoxal phosphate) ng/ml nmol/l Vitamin B pmol/l pg/ml Vitamin C mmol/l mg/dl Vitamin E (a-tocopherol) mg/dl mmol/l Zinc mmol/l mg/dl JANUAR_2010_ENGLISCH SEITE 85

88 5 Sample Stability (84) Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Acid phosphatase (ACP) Maximum storage time of samples before clinical chemical analyses and possible additives for sample-stabilization Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Clinical chemistry, serum/plasma, immunological tests 1hØ unstabilized 1 d 4mth Albumin 6 d 5 mth 5 mth 2.5 mth Alkaline phosphatase 4 d Ø 2 mth 7 d 7 d Ammonium 15 min in EDTA heparinate Ú 8h 8d 2h 8 d 5 mg NaHSO4/mL serum (ph 4 5) 3 w 2 h 15 min 5 mmol/l serine and 2 mmol/l borate Stabilizer Comments Unstabilized Serum > Plasma Stabilize after separation of serum Avoid contamination by sweat-ammonia Amylase 4 d Ø 1 yr 7 d 7 d Avoid contamination by saliva Antistreptolysin O 6 mth 2 d 2 d a1-antitrypsin 3 mth 5 mth 3 mth Anti-TSHR 1 mth 3 d Ref. 220 Apolipoprotein A-I 2 mth 3 d 1 d Only freeze once Apolipoprotein B 2 mth 3 d 1 d Only freeze once Bilirubin unstable Ø 6 mth 7 d 1 d Keep in the dark C3C-Complement 1 h 8 d 8 d 4 d Recommend plasma, pretreat serum C4-Complement 1 d 2 d 2 d CA mth 5 d CA d Ø 3mth 1mth 7d CA72 4 7d 3mth 1mth 7d CA d Ø 3mth 5d 3d Calcium totalionized Carcinoembryonic Antigen (CEA) Catecholamines Norepinephrine Epinephrine Dopamine 2dØ 15 min Ú 1d* 8mth 3w 2h 7d 3d* 3d 6mth 7d 7d 9 1 h (unstabilized) 1 mth >= 6mth >; stabilized 2d 1d Ceruloplasmin 3 mth 2 w 8 d Ca-titrated heparin Glutathione 1.2 mg/ ml + EGTA *24 h stable in gel tubes as primary tubes; 72 h stable after centrifugation in closed tubes JANUAR_2010_ENGLISCH SEITE 86

89 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Chloride 1 d Ø >1yr 7d 7d Cholesterol total- HDL- LDL- 7dÚ 2dÚ 1dØ 3mth 3mth 3mth Cholinesterase 7 d Ø 1 yr 1 yr 1 yr Copper 7 d > 1 yr 2 w 2 w Cortisol 7 d 3 mth 7 d 7 d C-reactive protein (CRP) 7d after centrif. 7d 7d 7d 7d 2d 1d 3yr 2mth 15d Creatinine 2 3 d Ú 3 mth 7 d 7 d Stabilizer Comments Creatine kinase (CK) 7 d Ø 4 w 7 d 2 d SH-donators Store in the dark CK-BB unstable b-crosslaps Serum Heparin plasma EDTA plasma 3mth 3mth 3mth 8h 1d 8d 8h 1d 1d Ref. 220 CYFRA mth 1 mth Ref. 220 Cystatin C 1 mth 1 w 2 d Erythropoietin 6 24 h 5 mth 2 w Estradiol (E2) 1 d 1 yr 3 d 1 d Estriol (E3) 1 yr 2 d 1 d Ferritin 1 yr 7 d 7 d a1-fetoprotein (AFP) 7 d 3 mth 7 d 3 d Folic acid 30 min Ø 8 w 6 h 30 min Ascorbic acid 2mg/mL Follicle stimulating hormone (FSH) 7dØ 1yr 2w 2w Free thyroxine (FT4) 3 mth 8 d 2 d Free triiodothyronine (FT3) 3mth 2w 1d Fructosamine 12 h Ú 2 mth 2 w 3 d g-gt 1 d Ø >1yr 7d 7d GLDH 4 w 7 d 7 d Glucose hemolysate plasma 10 min Ø 1dØ 7d 7d GOT (ASAT) 7 d Ø 3mth 7d 4d GPT (ALAT) 4 d Ø 7d 7d 3d 2dØ 2d Fluoride monoiodo acetate Nonenzymatic glycolysis, stability depends on the number of cells JANUAR_2010_ENGLISCH SEITE 87

90 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Growth hormone (STH, somatotropin) Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C 1d 3mth 8d 1d EDTA Stabilizer Comments Haptoglobin 8 d 3 mth 8 mth 3 mth Method-dependent HbA1c 3 d (EDTA-blood) 6 mth 7 d 3 d Human chorionic gonadotropin (hcg) Immunoglobulin A Immunoglobulin D Immunoglobulin E Immunoglobulin G Immunoglobulin M 17 d 11 d 17 d 1yr 3d 1d 8mth 6mth 6mth 8mth 6mth 8mth 7d 7d 8mth 4mth 8mth 7d 7d 4mth 2mth Insulin 15 min 6 mth 1 d 4 h Iron 2 h Ú > 1 yr 3 w 7 d Interference by EDTA, citrate, oxalate Lactate < 5 min, unstable ÚÚ 3 d 3 d 6d 3d 6d Mannose/fluoride, oxalate/monoiodo acetate with deproteinization Deproteinization recommended LDH 1 h Ú 6 w 7 d 7 d Serum > plasma (hemolysis) Lipase 1 yr 7 d 7 d Lipoprotein [a], (Lp [a]) Luteinizing hormone (LH) 7d 1yr 3d 1d a2-macroglobulin 7 d 7 d Magnesium 1 d Ú 1 yr 7 d 7 d Myoglobin 1 h Ø 3 mth 1 w 2 d Neuron specific enolase (NSE) 2 w 2 d Do not freeze 2hÚ 3 mth 7 d 7 d Heparin Freeze only once serum > plasma (platelets, hemolysis) Osmolality 3 mth 1 d 3 h P1NP 6 mth 5 d 24 h Ref. 220 pro BNP 12 mth 6 d 3 d Ref. 220 Parathyrin 6 h (24 h in EDTA) 6 mth 2 d 8 h EDTA Method-dependent Phosphate (inorg.) 1 h ÚÚ 1 yr 4 d 1 d Platelet-dependent (serum) Potassium 1 h ÚÚ 1 yr 1 w 1 w Serum > plasma (hemolysis, thrombocytolysis) JANUAR_2010_ENGLISCH SEITE 88

91 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Progesterone 7 d 1 yr 3 d 1 d Prolactin 2 d 1 yr 3 d 1 d Prostate specific antigen (PSA) total free Protein total electrophoresis Rheumatoid factor (RF) 7d 7d 1d 3mth 1mthÚ 1yr 3w 1mth 7d 4w 7d 7d 7d 6d 1d 1mth 3d 1d Sodium 4 d Ø 1yr 2wk 2wk Testosterone 7 d 1dÚ in women 1yr 3d 1d Thyroglobulin 2 d 1 mth 3 d 1 d Thyroid stimulating hormone (TSH) Thyroxine (T4) 7 d 1 mth 3 d 5 d Transferrin 11 d 6 mth 8 mth 4 mth Triglycerides 7 d Ú > 1 yr 7 d 2 d Triiodothyronine (T3) 3 mth 8 d 2 d Troponin T 8 h 3 mth 1 d 1 d Urea 1 d Ú 1yr 7d 7d Uric acid 7 d Ú 6mth 7d 3d Stabilizer Comments 1 mth 7 d Ref. 220 Vitamin A 2 yr 1 mth Protect from light Vitamin B1 1 yr Protect from light Vitamin B2 1 mth Protect from light Vitamin B6 Unstable without EDTA Vitamin B12 2 mth 2 d; serum in separation gel tubes: 1d Days Hours 30 min EDTA-Plasma Protect from light Ref d EDTA-Plasma Protect from light Vitamin C 3 h (4 C) 3 w 3 h Protect from light Vitamin D 3 d 3 d Metaphosphate (60 mg/ml) Protect from light Vitamin E 8 h Ø 1 yr 1 mth Protect from light Vitamin K unstable 3 mth unstable Protect from light Zinc 30 min Ú 1yr 2w 1w JANUAR_2010_ENGLISCH SEITE 89

92 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Differential leucocyte count Band neutrophils Segmented neutrophils Monocytes Lymphocytes Eosinophils Basophils 2 12 h 3 12 h 2 12 h 3h 4d 12 h 6 d 2h 2d Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Hematology Stabilizer Comments Dried blood smears are more stable Lower filling of sample tube decreases stability (EDTA Ú). Do not keep in the refrigerator. Instrument-dependent. Erythrocytes 4 d 7 d 4 d EDTA blood Erythrocyte sedimentation rate (ESR) 2h Temperaturedependent; 1 part of citrate, 4 parts of blood Hematocrit (centrif.) 1 d Ú 4h InK2-EDTA more stable than in K3-EDTA Hemoglobin in blood 4 d 7 d 4 d EDTA blood Leucocytes 7 d EDTA blood Reticulocytes 1 d EDTA blood Thrombocytes 7 d 4 d EDTA blood Coagulation, plasma/blood Antithrombin III 8 h 1 mth 2 w 7 d D-Dimer 8 h 6 mth 4 d 8 h Factor II 4 w 6 h Factor V 4 w 2 d 1 d Centrifugation at 4 C Factor VII unstable 6 h Factor VIII 2 w 4 h 3 h Factor IX 4 w 6 h Factor X 4 w 6 h Factor XI unstable 6 h Factor XII unstable 6 h Factor XIII 1 mth 4 h Fibrin monomers 1 d 3 mth 1 d 2 h Fibrinogen 8 h 1 mth 7 d 7 d Fibrin(ogen) degradation products (FDP) unstable ÚÚ 1 mth 1 d 3 h Add 10 U thrombin and 150 IU kallikrein per ml blood Heparin inhibits thrombin effect JANUAR_2010_ENGLISCH SEITE 90

93 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Fibrinopeptide A 2 h Hepato Quick 4 w 2 d 6 h Partial thromboplastin time (PTT) Stabilizer Comments 8 12 h 1 mth 2 8 h 2 8 h Reagent dependent; reduced stability in heparin plasma Protein C 1 mth 7 d 7 d Avoid repeated thawing Protein S 4 h 4 h 4 h Separate cell-free plasma after centrifugation Prothrombin time (PT) 8 h 1 mth 1 d 1 d Reagent dependent Reptilase time 1 mth 4 h 4 h Thrombin time 4 h Ú 1 mth 2 d 4 h Reagent dependent von Willebrand-factor 6 mth 7 d 2 d Blood gases Base excess < 15 min Ú 2 h Stability depends on ph Bicarbonate Unstable Recommended: 4 C, 30 min 2 w 7 d 1 d (closed) 1 h (open) Close the tube pco2 15 min 2 h Close the tube ph 15 minø 2 h Close the tube, decrease due to formation of lactate, increase due to loss of CO2 po2 15 min Ø 2 h Close the tube Therapeutic drug monitoring Benzodiazepine < 1 d 5 mth Ø 5 mth Ø Carbamazepine 2 d 1 mth 7 d 2 d Cyclosporine A+G 13 d 13 d 21 d EDTA Store the hemolysate Digitoxin 6 mth 3 mth 2 w Digoxin 6 mth 3 mth 2 w Disopyramide 5 mth 2 w Ethosuximide 5 mth 4 w Gentamicin 4 h 4 w 4 w 4 h JANUAR_2010_ENGLISCH SEITE 91

94 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Lidocaine 6 h Stabilizer Comments Lithium 1 h Ø 6 mth 7 h 1 d Do not use Li-heparinate Methotrexate 6 mth 3 d Protect from light Phenobarbital 2 d 6 mth 6 mth 6 mth Phenytoin 2 d 5 mth 4 w 2 d Unstable in SST tubes Primidone 5 mth 4 w Procainamide 6 mth 2 w Quinidine 1 d Theophylline 3 mth 3 mth 3 mth Tobramycin 1 mth 3 d < 2 h Lower values in heparin plasma Valproic acid 2 d 3 mth 7 d 2 d Urinanalysis Albumin 6 mth 1 mth 7 d Do not freeze (nephelometry) d-aminolevulic acid 1 mth 4 d 1 d ph 6 7 with 0.3 % NaHCO3 Protect from light Amylase 3 w 10 d 2 d Avoid contamination by saliva Calcium 3 w 4 d 2 d ph < 2 Crystallization upon cooling unless acidified Catecholamines Norepinephrine Epinephrine Dopamine 20 d >; 9 >= 4d 4d Citrate 4 w 1 d 1 vol % thymol, 5 ml/l; ph < 1.7 Cocaine 4 mth 3 w ph 5, ascorbic acid Copper 1 yr 7 d 3 d Creatinine 6 mth 6 d 2 d Cystine 1 yr 3 mth 7 d Acidify with HCl ph < 2 and sodium metabisulfite (250 mg/l) enhance stability: 20and+4 C: 1 yr +25 C: 3 w Unstable in native urine JANUAR_2010_ENGLISCH SEITE 92

95 Analyte Stability in primary sample (e.g. blood) at room temperature and tendency of change thereafter Stability in serum/plasma/blood/ CSF/urine 20 C 4 8 C C Stabilizer Comments Glucose 2 d 2 h 2 h Ø Decrease depends on the number of cells and bacteria 5-Hydroxyindole acetic acid 2d 2d 2h Acidify Hydroxyproline 5 d 5 d 5 d Acidify Immunoglobulin G (IgG) Iron >1yr 7d 3d 1 mth 7 d Do not freeze (nephelometry) Magnesium 1 yr 3 d 3 d ph < 2 a1-microglobulin 6 mth 1 mth 7 d Osmolality 3 mth 7 d 3 h Oxalate 4 mth (ph 1.5) unstable Ø unstable Ø ph 2 (HCl), 1 vol % thymol, 5 ml/l urine Vitamin C Ú ph unstable Ú unstable Ú unstable Ú Increases by formation of NH3 Phosphate, inorg. unstable 2 d (ph < 5) Porphobilinogen 1 mth (ph 6) 7d 4d (ph 6) 1 vol % thymol, 5mL/L Precipitates at alkaline ph ph 6 7 ph < 5 Ø protect from light Porphyrine 1 mth 7 d 4 d ph 6 7 Protect from light Potassium 1 yr 2 mth 45 d Protein 1 mth 7 d 1 d Sediment Casts Epithelial cells Erythrocytes Leucocytes Test strips Bacteria (nitrite) Erythrocytes Protein Sodium 1 yr 45 d 45 d Urea 4w 7d 2d 1d 1d 1h 1h 1h 1h 1h Do not freeze or store the urine refrigerated. Osmolarity > 300 mosmol/kg Uric acid unstable at ph < 7 unstable unstable 4 d Alkalize at ph > 8 Precipitates at ph < 7 Vanillinmandelic acid > 1 yr 7 d 7 d ph JANUAR_2010_ENGLISCH SEITE 93

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114 List of key words A Abbreviations, list of 4 Acetoacetate 14 Acetaminophen 102 Acetylsalicylicacid 102 Acid phosphatase (ACP) 14 a l -Acid glycoprotein 14 Adenosine monophosphate, 3l-5l-cyclic (camp) 14, 112 Adrenocorticotrophic hormone (ACTH) 14 Alanine aminotransferase (ALT, ALAT) 14 Albumin 16 CSF/serum ratio 122 Aldosterone 16 Alkaline Phosphatase 18 Aluminium 18 Amikacin 102 d-aminolevulic acid 112 Ammonium 20 a-amylase 20, 112 Amyloid A 20 Anion gap 20 Anti-DNase B 20 Anti-phospholipid antibodies (APA) 86 a 2 -Antiplasmin 86 Antistreptolysin O 20 Antithrombin III 86 Anti-thyroglobulin (Anti-TG) 20 Anti-thyroid-peroxidase (Anti-TPO) 22 a l -Antitrypsin 22 Apolipoprotein A-1 22 Apolipoprotein B 22 Ascites 128 Aspartase aminotransferase (AST, ASAT) JANUAR_2010_ENGLISCH SEITE 112

115 B Bacteria 108 Base excess 100 Benzodiazepine 102 Bicarbonate 100, 128, 129, 130, 133 Bile 129 Bilirubin 24, 110, 120 Bleeding time 86 Blood coagulation, scheme 149 Blood collection 8 Blood gases 100 Blood in stool 124 C C 3C -Complement 24 C 4 -Complement 24 C4bBP 86 CA CA CA CA Cadmium 24 Caffeine 102 Calcitonine 24 Calcium 26, 112, 128, 129, 130, 131, 132, 134 Carbamazepine 102 Carcino embryonic antigen (CEA) 26 Carnitine 26, 112 Casts 108 Catecholamines 26, 112 Cells, CSF 122 Ceruloplasmin 26 Chloramphenicol 102 Chloride 26, 112, 128, 129, 130, 131, 132, 135, 136 Cholesterol 28 Cholinesterase (CHE) 30 Dibucaine inhibition test 30 Chromium 30 Chymotrypsin 124, 126 Citrate 112, 126, 131 CO-Hb 76 Coelomic fluid 130 Complement system 153 Composition, stool 124 Conversion table (conventional units to SI units) 159 Copper 30, 112, 124 Coproporphyrins 161 Cortisol 30, 112 C-peptide 30, 114 C-reactive Protein (CRP) 30 Creatine kinase (CK) 32 Creatine kinase MB (CK-MB) 32 Creatinine 32, 114, 139 Creatinine clearance test 114, 139 b-crosslaps 34 Cyclosporine 102 CYFRA Cystatin C 34 Cystine 114 D D-Dimer 86, 133 Dehydroandrosterone sulfate (DHEAS) 34 Deoxypyridinolin 114 Differential leucocyte count 76 Digitoxin 102 Digoxin 102 Disopyramide 102 Dopamine 112 Duodenal fluid 130 E Elastase 36 Eosinophiles 76 Epinephrine 112 Erythrocyte sedimentation rate (ESR) 76 Erythrocytes 76 Erythropoietin 36 Estradiol (E2) 36 Estriol (E3) 36 Ethosuximide 102 Extravascular body fluids JANUAR_2010_ENGLISCH SEITE 113

116 F Factor II 88 Factor V 88 Factor VII 88 Factor VIII 88 Factor IX 88 Factor X 88 Factor XI 88 Factor XII 88 Factor XIII 36 Fatty acids, free 36 Ferritin 36 a l -Fetoprotein (AFP) 38 Fibrin monomers 88 Fibrinogen 90 Fibrin(ogen) degradation products (FDP) 90 Fibrinopeptide A 90 Fibronectin 90 Fluoride 38 Folic acid 38 Follicle stimulating hormone (FSH) 38 Free PSA/total PSA ratio 40 Free thyroxine (FT 4 ) 40 Free triiodothyronine (FT 3 ) 40 Fructosamine 40 Fructose 40, 114, 126 FTI 40 FT 4 I 42 Function tests 137 G Galactose 42, 114 Gallstones 120 Gastric juice 131 Gastrin 42 Gentamicin 102 Glomerular filtration rate 114 Glucose 42, 110, 114, 122, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137 Glucose-6-phosphate dehydrogenase (G6P-DH) 78 a-glucosidase 126 Glutamate dehydrogenase (GLDH) 44 Glutamate oxaloacetic transaminase (GOT) 22 Glutamate pyruvate transaminase (GPT) 14 g-glutamyl transferase (g-gt) 46 Glycerol 46 Growth hormone (STH, somatotropin) 46 H Haptoglobin 46 HbA 1c 46 Hematocrit (Hct, PCV) 78 Hemoglobin (Hb) in blood 78 in plasma 46 Hemoglobin composition 78 Hemopexin 46 Hemosperms 126 Heparin cofactor II 90 Hepatitis 155 Hepato Quick 90 High molecular weight kininogen (HMWKG) 90 Homocysteic acid 48 Human chorionic gonadotropin (hcg) 48, 128 Hydrogen (H 2 ) breath test 138 b-hydroxybutyrate 48 a-hydroxybutyrate dehydrogenase (a-hbdh) Hydroxycorticosteroids Hydroxyindole acetic acid Hydroxyprogesterone Hydroxyvitamin D 72 Hydroxyproline 114 I Immunoglobulin A (IgA) 48, 122, 134, 136, 147, 152 Immunoglobulin D (IgD) 48, 122 Immunoglobulin E (IgE) 48, 122 Immunoglobulin G (IgG) 50, 116, 122, 136, JANUAR_2010_ENGLISCH SEITE 114

117 Immunoglobulin G subclasses 50 Immunoglobulin light chains 52, 116 Immunoglobulin M (IgM) 50, 122, 136, 147, 152 Insulin 52 International normalized ratio (INR) 90 Iron 52, 116 Iron-binding capacity (IBC) 52 K Kappa/lambda ratio, urine 116 L Lactate 52, 122 Lactate dehydrogenase (LDH) 54 Lactoferrin 124 Lactose tolerance test 142 Lead 54 Lecithin 165 Leucine 165 Leucocytes 80, 108 Lidocaine 102 Lipase 54 Lipoproteins, composition 146 Lipoprotein a (Lp [a]) 54 Lithium 102 Luteinizing hormone (LH) 56 Lymph 131 Lysozyme 56, 116 M a 2 -Macroglobulin 56, 92 Magnesium 56, 116, 129, 134 Mannose binding protein (MBP) 56 MAR test 126 MCH 80 MCHC 80 MCV 82 Mercury 56, 116 Methemoglobin 82 Methotrexate 104 a l -Microglobulin 116, 135 b 2 -Microglobulin 56, 132, 135, 136 Milk, human 132 Mycophenolic acid 104 Myoglobin 56 N N-Acetylprocainamid (NAPA) 104 Nasal secretion 132 Neuron-specific enolase (NSE) 56 Nomograms Acid-base disorders 158 Body surface area (BSA) 141 Norepinephrine 112 N-terminal pro brain natriuretic protein (NT-proBNP) 58 O Oral glucose tolerance test 137 Osmolality 58, 116 Osmotic resistance of erythrocytes 82 Osteocalcin 58 Oxalate 116 P P1NP 58 Pancreatic elastase 124 Pancreatic juice 133 Parathyrin (PTH) 60 Partial thromboplastin time (PTT) 92 pco Peritoneal fluid 133 ph 100, 110, 126, 129, 131, 133, 134, 135, 136 Phenobarbital 104 Phenylalanine 167 Phenytoin 104 Phosphate, inorganic 60, 116, 128, 129, 130, 132, 134 Phosphohexose isomerase (PHI) 60 Phospholipids 128, 129, 132 Plasmin-a 2 -antiplasmin complex 92 Plasminogen 92 Plasminogen activator inhibitor (PAI) 94 Platelet factor 4 (PF4) 94 Pleural fluid 133 po Porphyrins JANUAR_2010_ENGLISCH SEITE 115

118 Potassium 60, 118, 128, 129, 130, 131, 132, 133, 134, 135, 136 Pre-analytical considerations 7 Prealbumin 62 Pregnancy-associated plasma protein A (PAPP-A) 62 Prekallikrein 94 Primidone 104 Procainamide 104 Procalcitonin 62 Progesterone 62 Prolactin 62 Prostate-specific antigen (PSA) 62 Protein 64, 110, 118, 122, 128, 129, 131, 132, 133, 134, 136 Protein C 94 Protein S 94 Protein-lipid-ratio 146 Prothrombin fragments Prothrombin time (PT) 96 Pyridinolin 118 Pyruvate 64, 131 Pyruvate kinase (erythrocytes) 82 Q Quinidine 104 R Reptilase time 86 Reticulocytes 82 Reticulocytes hemoglobin equivalent (RET-He) 82 Rheumatoid factor (RF) 64 S S Salicylic acid 104 Saliva 134 Sample collection 9 Sample stability 172 Sediment 108, 156 Selenium 64 Sexual hormone binding globulin (SHBG) 64 Sodium 64, 118, 128, 129, 130, 131, 132, 134, 135, 136 Sorbitol 64 Spermiogram 126 Squamous cell carcinoma antigen (SCC) 64 Stool 124 Sweat 135 Synovial fluid 136 T Tacrolimus 104 Tears 136 Testosterone 66 Thallium 66 Theophylline 106 Therapeutic drug monitoring 102 Thrombin-AT III-Komplex (TAT) 96 Thrombin coagulase 96 Thrombin time 96 Thrombocytes 84 b-thromboglobulin 96 Thrombophilia, risk factors 150 Thyroglobulin 66 Thyroid stimulating hormone (TSH) 66 Thyroxine (T 4 ) 66 Thyroxine binding capacity (as T 4 -uptake) 68 Tissue factor pathway inhibitor 96 Tissue plasminogen activator (t-pa) 98 Tobramycin 106 Total sperm count 126 Transferrin 68 Transferrin carbohydrate deficient (CDT) 68 Transferrin-receptor, soluble (stfr) 68 Transferrin saturation (TS) 68 Triglycerides 68, 128, 131 Triiodothyronine (T 3 ) 68 Troponin I 68 Troponin T 68 Tumor markers 154 T-uptake (free thyroxine binding capacity) JANUAR_2010_ENGLISCH SEITE 116

119 U Urea 70, 118, 128, 130, 131, 133, 134, 135 Uric acid 70, 118, 131, 134, 135, 136 Urinalysis 108 Urinary calculi 120 Urinary sediment 108 Urine status 108 Urine volume 110 Urine specific gravity 110 Urobilinogen 110 Notice V Valproic acid 106 Vancomycin 106 Vanilyylmandelic acid (VMA) 118 Vitamin A 72, 132 Vitamin B 1 72, 132 Vitamin B 2 72, 132 Vitamin B 6 72, 132 Vitamin B 12 72, 132 Vitamin C 72, 132 Vitamin D 72, 132 Vitamin E 74, 132 Vitamin K 74, 132 W von Willebrand factor (vwf) 98 X D-Xylose absorption test 143 Z Zinc 74, 126, JANUAR_2010_ENGLISCH SEITE 117

120 Notice Notice JANUAR_2010_ENGLISCH SEITE 118

121 Notice Notice JANUAR_2010_ENGLISCH SEITE 119

122 Notice JANUAR_2010_ENGLISCH SEITE 120